general-medicine geriatrics

CARG — Cancer and Aging Research Group Chemotherapy Toxicity Score

11-item predictive tool for grade 3–5 chemotherapy toxicity in adults ≥ 65 with cancer (Hurria 2011, validated 2016): age, tumour type, dose, polychemotherapy, haemoglobin, creatinine clearance and five geriatric assessment items. Score 0–23.

Age*

Cancer type*

Chemotherapy dose schedule*

Polychemotherapy (2 or more chemotherapy agents planned)*

Haemoglobin level (sex-specific)*

Creatinine clearance (Jelliffe formula, ideal body weight)*

Hearing (self-reported)*

Falls in the past 6 months*

Walking one block (limited by health)*

Limitation in social activity due to physical or emotional problems in the past 4 weeks*

Requires assistance taking medications*

Score interpretation

Low Chemotherapy Toxicity Risk (CARG 0-5) 0–5

CARG 0-5 -- approximately 30% risk of grade 3-5 chemotherapy toxicity

→ Proceed with planned standard-dose chemotherapy regimen; standard monitoring per oncology protocol; document CARG score in notes; ensure patient has written information about expected side effects and when to contact the acute oncology service; community/GP support for monitoring; consider G8 screening if not done; reassess toxicity at each cycle.

Intermediate Chemotherapy Toxicity Risk (CARG 6-9) 6–9

CARG 6-9 -- approximately 52% risk of grade 3-5 chemotherapy toxicity

→ Discuss with MDT: consider dose reduction (typically 20-25% reduction in first cycle, escalate if tolerated); consider comprehensive geriatric assessment (CGA) to identify modifiable risk factors; address hearing impairment (audiology referral); fall prevention programme (physiotherapy, bone protection); optimise anaemia (iron supplementation, EPO if appropriate, transfusion threshold); renal dose adjustment for renally cleared drugs; proactive toxicity monitoring; patient information on reporting acute oncology symptoms.

High Chemotherapy Toxicity Risk (CARG 10 or above) 10–23

CARG 10 or above -- approximately 83% risk of grade 3-5 toxicity; significant caution required

→ Urgent MDT discussion before initiating chemotherapy; comprehensive geriatric assessment (CGA) strongly recommended; consider significant dose reduction (25-50%) or switch to less toxic regimen; discuss goals of care and treatment intent with patient -- curative vs palliative; involve palliative care early if patient frail; optimise all modifiable factors: anaemia, renal function, falls risk, polypharmacy; consider clinical trial eligibility for less toxic approaches; ensure patient and family fully informed of toxicity risk vs benefit; document shared decision-making discussion.

Interpretation bands for the CARG. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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