ISBN 9783843944052

978-3-8439-4405-2, Reihe Klinische Pharmazie

Imke Ortland
Evaluating onco-geriatric scores and medication risks to improve cancer care for older patients

240 Seiten, Dissertation Rheinische Friedrich-Wilhelms-Universität Bonn (2020), Softcover, A5

Zusammenfassung / Abstract

The cancer therapy of older patients is challenging, being more complex than the therapy of younger patients. Short tools combining geriatric assessment with oncologic parameters were developed for predicting toxicity during chemotherapy: the CARG (Cancer and Aging Research Group) and the CRASH (Chemotherapy Risk Assessment Scale for High Age Patients) score. The aim was to compare the scores regarding their predictive performance in a clinical routine setting.

In a prospective, observational study, the CARG and the CRASH score were assessed for patients ≥ 70 years before the start of their systemic cancer treatment. The CARG score predicts severe overall toxicity. The CRASH score is divided into three subcategories, predicting severe overall, hematologic, and nonhematologic toxicity. Moreover, physicians’ judgments regarding the patients’ toxicity risk were documented. Grade ≥ 3 toxicity according to the Common Terminology Criteria for Adverse Events (CTCAE) was captured from medical records. The evaluation study of the CARG and the CRASH score comprised 120 patients (50% female, mean age 77.2 years). The predictive performances of the CARG score and the combined CRASH score were similar for overall and nonhematologic toxicity. For hematologic toxicity, the hematologic CRASH score performed better than the CARG score. Neither physicians’ judgment nor the ECOG nor age indicated adequate predictive performance for overall toxicity.

In conclusion, the CARG and the CRASH score exhibited similar predictive performance for overall and nonhematologic toxicity. However, the hematologic CRASH score should be preferred for predicting hematologic toxicity. Both scores performed better than clinical judgment alone and thus may be used for supporting therapy decisions in clinical routine.