CARG Chemotherapy Toxicity Tool for Older Patients
Cancer and Aging Research Group (CARG) chemotherapy toxicity prediction tool. Predicts risk of grade 3-5 toxicity in patients aged 65 or above receiving chemotherapy. Score 0-3 = low risk (25% toxicity); 4-5 = intermediate (50%); 6 or above = high risk (70%). Validated by Hurria et al. 2011 in 500 patients across 7 cancer centres. Guides dose modification and geriatric support decisions.
Score interpretation
CARG 0-5 -- approximately 25% 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.
CARG 6-9 -- approximately 50% 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.
CARG 10 or above -- approximately 70% 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; TROG (tumour response over geriatric oncology) pathway; ensure patient and family fully informed of toxicity risk vs benefit; document shared decision-making discussion.
Interpretation bands for the CARG-TT. Apply clinical judgement and local guidance.
References
- Hurria A et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457-3465.
- 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.
Related
Curated clinical cross-links plus same-class fallbacks.
- Cisplatin · Platinum Chemotherapy — Head and Neck Cancer
- Dopamine (ICU — Vasopressor/Inotrope) · Catecholamine (Dose-Dependent Vasopressor/Inotrope)
- Hydroxocobalamin (High-Dose — Cyanide Antidote) · Cyanide Antidote (Vitamin B12 Precursor at High Dose)
- Dopamine hydrochloride · Inotrope / vasopressor (dose-dependent)
- Enalapril with hydrochlorothiazide · ACE inhibitor + thiazide diuretic (fixed-dose)
- Amiloride with Bumetanide · Potassium-Sparing Diuretic + Loop Diuretic (Fixed-Dose Combination)
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.