CRASH Score — Chemotherapy Risk Assessment Scale for High-Age
Predicts severe chemotherapy toxicity (grade 4 haematological or grade 3–4 non-haematological) in adults ≥ 70 (Extermann 2012) from diastolic BP, IADL, LDH, ECOG, MMSE, MNA and the regimen's toxicity (Chemotox). Combined score 0–12.
Score interpretation
CRASH 0-3 -- severe chemotherapy toxicity in about 50% (Extermann 2012)
→ Standard chemotherapy planning; consider G-CSF prophylaxis if febrile neutropenia risk > 20% (EORTC / ASCO guidelines); dose reductions for borderline renal function; discuss toxicity risks with patient; CARG-TT assessment as complementary tool; geriatric oncology review; nutritional assessment (NRS-2002 or MNA); physical therapy referral for fitness optimisation; weekly FBC monitoring; antiemetic prophylaxis per regimen emetogenicity.
CRASH 4-6 -- severe chemotherapy toxicity in about 58%
→ Standard chemotherapy planning; consider G-CSF prophylaxis if febrile neutropenia risk > 20% (EORTC / ASCO guidelines); dose reductions for borderline renal function; discuss toxicity risks with patient; CARG-TT assessment as complementary tool; geriatric oncology review; nutritional assessment (NRS-2002 or MNA); physical therapy referral for fitness optimisation; weekly FBC monitoring; antiemetic prophylaxis per regimen emetogenicity.
CRASH 7-9 -- severe chemotherapy toxicity in about 77%
→ Geriatric oncology assessment (CGA: comprehensive geriatric assessment); dose-reduced regimen discussion (50-75% standard dose with escalation based on tolerance); G-CSF prophylaxis from cycle 1 (filgrastim 5 mcg/kg/day SC days 5-12 or pegfilgrastim 6 mg day 2); consider oral regimens if IV regimen very toxic; discuss best supportive care vs treatment; patient-reported outcome monitoring (PRO-CTCAE); carer involvement in monitoring; weekly FBC, LFTs, renal function; telemedicine follow-up between cycles; CARG-TT for comparison; proactive antiemetic, antibiotic prophylaxis; close monitoring for grade 3-4 events requiring hospitalisation.
CRASH 10-12 -- severe chemotherapy toxicity in about 79%
→ Geriatric oncology assessment (CGA: comprehensive geriatric assessment); dose-reduced regimen discussion (50-75% standard dose with escalation based on tolerance); G-CSF prophylaxis from cycle 1 (filgrastim 5 mcg/kg/day SC days 5-12 or pegfilgrastim 6 mg day 2); consider oral regimens if IV regimen very toxic; discuss best supportive care vs treatment; patient-reported outcome monitoring (PRO-CTCAE); carer involvement in monitoring; weekly FBC, LFTs, renal function; telemedicine follow-up between cycles; CARG-TT for comparison; proactive antiemetic, antibiotic prophylaxis; close monitoring for grade 3-4 events requiring hospitalisation.
Interpretation bands for the CRASH. Apply clinical judgement and local guidance.
References
- Extermann M et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118(13):3377-3386.
- Mohile SG et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018;36(22):2326-2347.
Related
Curated clinical cross-links plus same-class fallbacks.
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Hydroxocobalamin (High-Dose — Cyanide Antidote) · Cyanide Antidote (Vitamin B12 Precursor at High Dose)
- Thiamine (IV/IM — Pabrinex) · Vitamin B1 (Thiamine) — deficiency treatment / Wernicke's encephalopathy prevention
- Folinic Acid (Calcium Folinate / Leucovorin) · Antidote / Chemotherapy Support
- Calcium chloride · IV calcium salt (high elemental calcium)
- Zoledronic Acid · Bisphosphonate (IV)
- Falls Assessment in Older Adults · NICE CG161 2013
- Anaemia Investigation · BSH / NICE
- Lower Respiratory Tract Infection (Primary Care) · NICE NG138 / NICE antimicrobial guidance
- Hypertension Management · NICE NG136 2019
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.