Cancer Aging Research Group (CARG) score in older adults undergoing curative intent chemotherapy: a prospective cohort study

Abstract

Importance: The Cancer Aging Research Group (CARG) toxicity score is used to assess toxicity risk in geriatric patients receiving chemotherapy.

Objective: The primary aim was to validate the CARG score in geriatric patients treated with curative intent chemotherapy in predicting grade 3-5 toxicities.

Design: This was a longitudinal prospective observational study.

Setting: Tata Memorial Hospital, Mumbai, India, a tertiary cancer care referral centre.

Participants: Patients, aged ≥65 years, with gastrointestinal, breast or gynaecological stage I-III cancers being planned for curative intent chemotherapy. A total of 270 patients were required for accrual in the study.

Exposures: Total risk score ranged from 0 (lowest toxicity risk) to 19 (highest toxicity risk).

Main outcomes and measures: The primary endpoint of the study was to evaluate whether the CARG risk score predicted for grade 3-5 toxicities.

Results: The study cohort of 270 patients had a mean age of 69 (65-83) years, with the most common cancers being gastrointestinal (79%). Fifty-two per cent of patients had atleast one grade 3-5 toxicity. The risk of toxicity was increased with an increasing risk score (42% low risk, 51% medium risk and 79% high risk; p<0.001). There was no association between either Eastern Cooperative Oncology Group (ECOG) performance status (p=0.69) or age-adjusted Charlson Comorbidity Index (p=0.79) risk categories and grade 3-5 chemotherapy toxicities.

Conclusions and relevance: This study validates the CARG risk score in predicting for grade 3-5 toxicities in geriatric oncology patients receiving curative intent chemotherapy and can be considered as the standard of care before planning chemotherapy in every elderly patient.

Trial registration number: CTRI/2016/10/007357; Results.

Keywords: adult oncology; adverse events; breast tumours; chemotherapy; gastrointestinal tumours; gynaecological oncology.

Figure 1

CARG (A) versus (B) ACCI versus (C) ECOG PS predict grade 3–5 toxicities. ACCI, age-adjusted Charlson Comorbidity Index; CARG, Cancer Aging Research Group; PS, performance status.