CRASH Score for Chemotherapy Risk Assessment in Elderly Patients
Predicts risk of severe (grade 3-4) haematological and non-haematological toxicity from chemotherapy in patients aged >= 65 years. Guides toxicity risk counselling and dose modification decisions in older cancer patients.
Score interpretation
CRASH 0-4 -- moderate toxicity risk (~25% grade 3-4 haematological toxicity)
→ Standard chemotherapy planning; consider G-CSF prophylaxis if febrile neutropenia risk > 20% (based on regimen, MASCC, 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 5-9 -- high risk (~65% grade 3-4 haematological toxicity)
→ 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 Score. 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.
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- International Staging System for Multiple Myeloma (ISS) · Oncology
- CISNE Score for Febrile Neutropenia · Oncology
- 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)
- Amlodipine with Valsartan · Calcium-Channel Blocker + ARB (Fixed-Dose Combination Antihypertensive)
- 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.