Older patients are vulnerable to treatment related toxicities such as myelosuppression, nausea and vomiting, and fatigue.1 Hurria et al2 published a risk stratification schema known as the Cancer and Aging Research Group (CARG) prediction tool which utilised independent variables to predict the risk of chemotherapy toxicity in older patients. Hurria et al3 externally validated its CARG prediction tool in eight hospitals in the United States.
We aim to evaluate the ability of the CARG score to predict risk of chemotherapy toxicity in patients older than 70 years receiving treatment in an Australian tertiary oncology service, and to determine its clinical utility. A single centre, prospective cohort study was designed with he target population patients over the age of 70 with a history of cancer who were being considered for commencement of new or a new line of systemic therapy at St Vincent’s Hospital in Melbourne, and their treating oncologists.
27 patients were prospectively enrolled into the study over a 6 month period. An average CARG score of 9 (66% risk of grade 3 or greater toxicity from chemotherapy) were calculated with a range from 3 (24% risk) to 14 (90% risk). Of those who went on to receive systemic chemotherapy, 65% of patients developed grade 3 or greater treatment related toxicities. 67% of the time clinicians found the estimated toxicity score higher than anticipated. 81% of the time clinicians found the CARG online scoring tool easy to use. 33% of the time clinicians felt the consultation took longer to finish by using the CARG score, compared to 44% of the time when it did not. 52% of the time clinicians found the CARG score useful; the CARG score was found to be less useful in patients with Head and Neck cancer and/or Small Cell Lung Cancer.