Oncology Scoring System
Department of Pharmacology · pharmaadvance.in · MBBS · PG · Consultants
Performance Status
Patient Performance & Function
3 tools
Select the grade that best describes the patient's current functional status. ECOG ≤2 is generally required for most chemotherapy trials. ECOG 0–1 for intensive regimens.
0
Fully active, able to carry on all pre-disease activities without restriction.
1
Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature.
2
Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about >50% of waking hours.
3
Capable of only limited self-care; confined to bed or chair >50% of waking hours.
4
Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair.
ECOG Performance Status
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KPS 100 = normal; KPS 0 = dead. KPS ≥70 generally required for standard chemotherapy. KPS <50 suggests best supportive care. Correlates with ECOG: KPS 100–80 ≈ ECOG 0–1; KPS 70–60 ≈ ECOG 2; KPS 50–30 ≈ ECOG 3; KPS ≤20 ≈ ECOG 4.
100
Normal; no complaints; no evidence of disease.
90
Able to carry on normal activity; minor symptoms of disease.
80
Normal activity with effort; some signs or symptoms of disease.
70
Cares for self; unable to carry on normal activity or do active work.
60
Requires occasional assistance but is able to care for most of personal needs.
50
Requires considerable assistance and frequent medical care.
40
Disabled; requires special care and assistance.
30
Severely disabled; hospitalization indicated though death not imminent.
20
Very sick; hospitalization necessary; active supportive treatment necessary.
10
Moribund; fatal processes progressing rapidly.
Karnofsky Performance Scale
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Paediatric equivalent of Karnofsky scale. Assesses play activity as a functional marker in children. Lansky ≥70 generally required for most paediatric oncology protocols.
Lansky Play Performance Scale
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Dose Calculators
Chemotherapy Dose Calculators
4 tools
BSA is used to calculate chemotherapy doses (mg/m²). Mosteller formula: √(Height × Weight / 3600). DuBois formula: 0.007184 × H⁰·⁷²⁵ × W⁰·⁴²⁵. Both results are shown simultaneously.
Body Surface Area
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Calvert formula: Carboplatin dose (mg) = Target AUC × (GFR + 25). GFR is typically estimated by Cockcroft-Gault. Use AUC 4–5 for second-line/compromised renal function; AUC 5–6 for first-line ovarian; AUC 6–7 for first-line NSCLC.
AUC 4
AUC 5
AUC 6
AUC 7
Carboplatin Dose
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CrCl = [(140 − Age) × Weight / (72 × SCr)] × 0.85 (if female). Use ideal body weight if obese. Required before each cycle of cisplatin, carboplatin, methotrexate, and other renally-cleared agents.
Male
Female
Creatinine Clearance (CrCl)
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ANC = Total WBC × (% Neutrophils + % Bands) / 100. ANC <500/μL = severe neutropenia. ANC <1000/μL = neutropenia. Normal: 1800–7700/μL.
Absolute Neutrophil Count
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Prognosis
Cancer-Specific Prognostic Scores
6 tools
5 independent risk factors — each adds 1 point. Score predicts 5-year overall survival in aggressive non-Hodgkin lymphoma treated with R-CHOP. aaIPI (age-adjusted) uses 3 factors for patients <60 yrs.
Age > 60 years+1
LDH > upper limit of normal+1
ECOG Performance Status ≥ 2+1
Ann Arbor Stage III or IV+1
Extranodal sites > 1+1
IPI Score
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FLIPI predicts prognosis in follicular lymphoma. Low risk (0–1): 91% 5-yr OS; Intermediate (2): 78%; High (3–5): 52% 5-yr OS. FLIPI-2 uses different parameters (β2-microglobulin, longest diameter, Hb, BM involvement, age).
Age > 60 years+1
Ann Arbor Stage III or IV+1
Haemoglobin < 12 g/dL+1
Serum LDH > upper limit of normal+1
Number of nodal areas > 4+1
FLIPI Score
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ISS uses serum β2-microglobulin and albumin. R-ISS adds LDH and cytogenetics (del17p, t(4;14), t(14;16)) for revised staging. R-ISS Stage III: del17p or t(4;14) or t(14;16) AND LDH > ULN.
< 3.5
3.5–5.5
> 5.5
≥ 3.5
< 3.5
Normal
> ULN
Absent
Present
ISS / R-ISS Stage
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NPI = (0.2 × tumour size in cm) + lymph node stage + histological grade. NPI guides adjuvant chemotherapy decisions. Good prognosis (<3.4): surgery alone may suffice. Moderate (3.4–5.4): adjuvant chemo. Poor (>5.4): intensive adjuvant therapy.
Stage 1 (No nodes)
Stage 2 (1–3 nodes)
Stage 3 (4+ nodes)
Nottingham Prognostic Index
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IPSS-R uses 5 components: cytogenetic risk group, BM blast%, haemoglobin, platelet count, and ANC. Guides transplant decisions and treatment intensity.
IPSS-R Score
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Sokal score = exp[0.0116(age−43.4) + 0.0345(spleen−7.51) + 0.188((platelets/700)²−0.563) + 0.0887(blasts−2.10)]. Low <0.8; Intermediate 0.8–1.2; High >1.2. Predicts response to imatinib.
Sokal Score
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VTE Risk
Venous Thromboembolism Risk in Cancer
3 tools
Predicts VTE risk in ambulatory cancer patients receiving chemotherapy. Score ≥2: consider prophylactic anticoagulation (DOAC — rivaroxaban/apixaban). Validated for multiple tumour types. ASCO 2023 recommends discussing prophylaxis for all high-risk (≥2) patients.
Very high risk site: Stomach or Pancreas+2
High risk site: Lung, Lymphoma, Gynaecologic, Bladder, Testicular+1
Pre-chemotherapy platelet count ≥ 350 ×10³/μL+1
Haemoglobin < 10 g/dL OR use of ESA (EPO/darbepoetin)+1
Pre-chemotherapy WBC > 11 ×10³/μL+1
BMI ≥ 35 kg/m²+1
Khorana VTE Risk Score
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Padua score ≥4: high VTE risk — initiate pharmacological prophylaxis (LMWH) unless bleeding risk is high. Score <4: low risk — early ambulation. Validated in hospitalised medical patients.
Active cancer (local or distant metastases; or chemotherapy/RT within 6 months)+3
Previous VTE (except superficial vein thrombosis)+3
Reduced mobility (anticipated bed rest ≥3 days)+3
Known thrombophilia (thrombophilic disorder)+3
Recent (<1 month) trauma or surgery+2
Elderly age ≥ 70 years+1
Heart and/or respiratory failure+1
Acute MI or ischaemic stroke+1
Acute infection and/or rheumatological disorder+1
Obesity (BMI ≥ 30 kg/m²)+1
Ongoing hormonal treatment+1
Padua Prediction Score
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Vienna CATS score adds soluble P-selectin (>53.1 ng/mL = +3.5 pts) and D-dimer (>1.44 μg/mL = +2 pts) to the Khorana clinical variables. Score >5: high risk (6-month VTE ~35%). Particularly useful for lung and gastrointestinal cancers.
Khorana risk factor ≥ 2 (use Khorana calculator above)+2
Soluble P-selectin > 53.1 ng/mL+3.5
D-dimer > 1.44 μg/mL+2
CATS Score
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Febrile Neutropenia
Infection & Neutropenia Risk Assessment
2 tools
MASCC ≥21: low risk — consider oral antibiotics (ciprofloxacin + amoxicillin-clavulanate) + early discharge. MASCC <21: high risk — IV antibiotics + hospitalisation. Validated across multiple studies; IDSA and ASCO endorsed.
Burden of illness: no or mild symptoms (asymptomatic or mild illness)+5
Burden of illness: moderate symptoms (moderate illness — choose only one burden item)+3
No hypotension (systolic BP > 90 mmHg)+4
No COPD+4
Solid tumour OR haematological malignancy with no previous fungal infection+4
No dehydration requiring parenteral fluids+3
Outpatient status at time of fever+3
Age < 60 years+2
MASCC Score
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CISNE outperforms MASCC specifically in clinically stable, solid-tumour patients with febrile neutropenia. Score 0: 1.1% complication rate (safe for outpatient). Score ≥3: 36% complication rate — hospitalise.
ECOG Performance Status ≥ 2+2
Stress-induced hyperglycaemia (glucose > 121 mg/dL without prior diabetes)+2
Chronic cardiovascular disease (not HTN)+1
NCI mucositis Grade ≥ 2+1
Monocytes < 200/μL+1
Chronic obstructive pulmonary disease (COPD)+1
CISNE Score
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Quality of Life
Patient-Reported Outcome Measures
3 tools
Patient rates each symptom 0 (none) to 10 (worst possible). Total Distress Score (TDS) = sum of all 9 items (0–90). Each symptom ≥4 considered clinically significant. Used at every consultation in palliative/supportive oncology.
Total Distress Score (TDS)
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BPI Pain Severity Score = mean of 4 pain items (worst, least, average, current pain). BPI Interference Score = mean of 7 interference items. Mild pain: 1–3; Moderate: 4–6; Severe: 7–10. Guides opioid escalation (WHO analgesic ladder Step 2 vs 3).
BPI Score
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Select the most emetogenic agent in the regimen. Patient risk factors (female sex, <50 yrs, low alcohol use, motion sickness history, prior CINV) increase risk by 1 level. MASCC/ESMO 2023 antiemetic guidelines.
Emetogenic Risk & Prophylaxis Protocol
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Palliative Care
Palliative Performance & Prognosis
3 tools
PPS is the palliative care adaptation of Karnofsky. Incorporates oral intake and level of consciousness — critical in end-of-life assessment. PPS 10–20%: median survival days. PPS 30–40%: weeks. PPS 50–60%: months.
Palliative Performance Scale
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PPI >6: >3 weeks survival unlikely (sensitivity 83%, specificity 85%). PPI >4: predicts <6 weeks. Validated in Japanese and Western populations. Useful for anticipatory prescribing and family discussions.
Palliative Prognostic Index
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PaP score predicts 30-day survival probability. Group A (0–5.5): 70% probability; Group B (5.6–11): 30–70%; Group C (>11): <30% probability of surviving 30 days. Incorporates clinician prediction of survival + laboratory values.
PaP Score
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ADR · Pharmacovigilance
Adverse Drug Reaction Causality
2 tools
Standard ADR causality assessment tool. Answer Yes / No / Do Not Know for each question. Definite ≥9 · Probable 5–8 · Possible 1–4 · Doubtful ≤0. File report at pharmaadvance.in/adr-report/ if Probable or Definite.
Naranjo Score
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📋 File ADR Report: pharmaadvance.in/adr-report/ · CDSCO compliant · Required for pharmacovigilance
WHO-UMC criteria assess ADR causality based on a structured checklist. Tick applicable criteria then select the appropriate category. Used for VigiBase and global adverse drug reaction reporting.
Plausible time relationship between drug intake and onset
Consistent with known pharmacology/toxicology of the drug
Improved on withdrawal (positive dechallenge)
Reappeared on re-administration (positive rechallenge)
Alternative cause cannot reasonably explain the event
Confirmed by objective evidence (lab test, imaging)
Previously known adverse reaction to this drug class
WHO-UMC Causality Category
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