CARG CRASH Chemotherapy Toxicity Risk Calculator

CARG and CRASH calculators explanation and clinical context These two validated tools help clinicians estimate the probability of severe chemotherapy related toxicity in older adults receiving cytotoxic chemotherapy. The CARG model uses eleven pre chemotherapy variables including age at or above 72 years cancer type planned chemotherapy dosing number of chemotherapy drugs patient reported items from a brief geriatric assessment and two laboratory values to yield a total score that stratifies patients into low intermediate and high risk for grade 3 to 5 toxicity. The CARG risk categories in derivation and validation cohorts were low zero to five points intermediate six to nine points and high ten to nineteen points and were associated with progressively higher observed rates of grade 3 to 5 events.

The CRASH instrument offers a complementary approach by computing separate hematologic and non hematologic subscores using clinical variables laboratory values and an index of chemotherapy regimen toxicity represented by the MAX two index. Hematologic and non hematologic subscores are combined into a single score and mapped to four risk categories low intermediate low intermediate high and high. Both tools were developed and validated in prospective cohorts and may inform shared decision making treatment intensity modifications and closer monitoring or supportive measures for patients identified at higher risk.

These tools do not replace clinical judgment and may be less applicable to patients receiving targeted therapies biologics or immunotherapy. Clinicians should interpret results alongside comprehensive clinical assessment and consider individual regimen details dose modifications and supportive measures when needed. References J Clin Oncol Hurria A Togawa K Mohile SG and colleagues Predicting chemotherapy toxicity in older adults with cancer A prospective multicenter study J Clin Oncol 2011.

JAMA Network Open Pang A and colleagues Use of the Cancer and Aging Research Group predictive model in a multiethnic older adult population 2022. Extermann M and colleagues Chemotherapy Risk Assessment Scale for High Age Patients CRASH model derivation and validation 2012. MDCalc and related clinical calculator summaries for CARG and CRASH provide implementation guidance and tables used in bedside calculators.