Yale Cancer Center researchers show using a validated risk calculator helped drive informed treatment decisions in older patients with cancer. Yale oncologists identified the Cancer and Aging Research Group (CARG) calculator as a quick and helpful tool in assessing chemotherapy toxicity probability in geriatric patients, leading to meaningful changes in treatment. The data will be presented on September 25, 2021 at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium.
“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. “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.”
In the study, researchers assessed patients 65 years old and older diagnosed with cancer and treated at Smilow Cancer Hospital Care Centers in Connecticut, a network of community-based oncology clinics, which are part of Yale Cancer Center. Physicians used the CARG tool to document toxicity scores for 10 geriatric patients starting a new chemotherapy regimen and completed a post survey between March and June 2021. The survey results captured perceived clinical value, time commitment, and barriers to implementation. Baseline data was collected in February 2021 and included geriatric patients receiving a new chemotherapy regimen for a solid tumor.
Study results showed 180 consecutive new chemotherapy starts in geriatric patients. The CARG score utilization in new chemotherapy starts increased from 6.5% of new cases during the first month, to 26.4% in the third month. According to the data, 82% of providers found the CARG score helpful in discussing chemotherapy risks with patients. In 32% of cases, the CARG score led to a decision to dose attenuate, and in 15% of cases, the CARG score led to a different treatment regimen. 65% of oncologists reported spending 5 minutes calculating toxicity, and 88% spent 10 minutes. 89% of oncologists reported the 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. “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.”
Other Yale authors involved in this study include: Paula Pike, Russell Lewis, MD, Jeremy S. Kortmansky, MD, and Anne C. Chiang, MD, PhD.