Toxicity Calculators Prove Valuable Tool in Geriatric Oncology

The Cancer and Aging Research Group (CARG) calculator is a quick and helpful tool to help assess chemotherapy toxicity in geriatric patients, according to research highlighted in a press release by the Yale School of Medicine.¹

Current American Society of Clinical Oncology (ASCO) Geriatric Oncology Guidelines recommend the completion of both a geriatric assessment and a chemotherapy risk assessment on all oncology patients 65 years of age and older in order to perform an informed treatment selection. However, despite ASCO guidance, validated tools such as the CARG calculator, and research confirming improved patient outcomes, oncologists’ utilization of risk calculators has been limited.²

“Older Americans are the fastest-growing segment of society and cancer risk increases with age,” said Alexander Mbewe, MD, a postdoctoral fellow at Yale Cancer Center, in the press release. “With older patients having unique issues and concerns compared with the younger population, we are constantly looking for tools like the CARG calculator to add value to the care of these patients.”

Results from the real-world analysis of CARG’s efficacy were presented at the 2021 annual ASCO Quality Care Symposium. The study included patients 65 years of age or older who were diagnosed with cancer and treated at Smilow Cancer Hospital Care Centers in Connecticut. These centers are part of a community-based oncology clinical network that is part of the Yale Cancer Center. 

The study included 36 physicians who agreed to complete 5 CARG tools, document toxicity scores in an electronic medical record, and then complete a post-survey on the experience between March and June 2021. Education was provided to care providers on both the survey and CARG. The survey asked questions about perceived clinical value, time commitment, and barriers to implementation. Baseline data was collected on geriatric patients receiving a new chemotherapy regimen for a solid tumor during February 2021.

In total, 180 new chemotherapy starts in geriatric patients were monitored. The analysis found that the CARG utilization score rose from 6.5% of new cases in the first month to 26.4% in the third month. The vast majority of providers, 82%, said that the CARG score was helpful in discussing chemotherapy risks with patients.

CARG score lead to a decision to dose attenuate in 32% of cases. It led to the selection of a different treatment regimen in 15% of cases. Eighty-eight percent of oncologists surveyed reported that they spent 10 minutes calculating toxicity while 65% reported spending 5 minutes calculating toxicity. Eighty-nine percent of the oncologist surveyed said that the reported CARG score was worth the added time. 

“We are now in the process of assessing clinical outcomes correlated with the CARG calculator,” said Jane Kanowitz, MD, assistant professor of Clinical Medicine (Medical Oncology) at Yale Cancer Center, in the press release. “We expect the results to further drive utilization of a geriatric risk assessment as part of shared decision making in our oncology clinics and hopefully, in all cancer centers in the future.”

_REFERENCES:

_{1.Yale Cancer Center study demonstrates efficacy of risk calculator in treating geriatric patients with cancer. Yale School of Medicine. Press release. September 25, 2021. Accessed September 28, 2021. https://bit.ly/39Izu8D.}

_{2.Mbewe A, Pike P, Lewis R, et al. Implementing the cancer and aging research group (CARG) tool in the ambulatory oncology setting to drive informed treatment selection. J. Clin. Oncol. 2021;39(28):209. DOI: 10.1200/JCO.2020.39.28_suppl.209.}