Performance status is a central factor in the care of MM, and should be clearly documented in the patient’s medical record.

Performance status should be measured and recorded using an established scale such as the Karnofsky scale or the Eastern Cooperative Oncology Group (ECOG) scale.

It is also important to evaluate and document comorbidities involving major organ systems (e.g. renal, cardiac, respiratory), overall functional status and physiological robustness because these may impact on treatment strategies. These issues are particularly important in the geriatric context of MM, given that the median age of diagnosis is over 70 years old (Quach & Prince 2019). There are many well established geriatric assessment tools that incorporate comorbidities, patient performance status, frailty and vulnerability. For MM, the most widely used is the IMWG geriatric assessment tool (Engelhard 2016).

These provide individualised frailty scores that are useful to minimise adverse events when choosing a therapy (refer to the online myeloma frailty score calculator <www.myelomafrailtyscorecalculator.net>).