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- W2244293385 abstract "9000 Background: We do not have a good tool to assess the individual risk of severe toxicity from chemotherapy in clinic. Such a tool would be especially useful for older patients, who are very diverse in health status and functional reserve. Methods: Patients were from 7 academic and community centers in Florida. They were 70 and older, initiating chemotherapy. Toxicity was per Common Toxicity Criteria v. 3.0. Grade 4 hematologic (H) or grade 3-4 non-hematologic (NH) toxicity was defined as severe. Age, sex, BMI, diastolic BP (DBP), cancer stage, comorbidity (CIRS-G), polymedication, CBC, liver tests, LDH, creatinine clearance (CrCl), albumin, self-rated health, ECOG PS, Instrumental Activities of Daily Living (IADL), geriatric depression scale, Mini-Mental Status (MMS), mini-nutritional assessment (MNA), marrow invasion, previous chemotherapy, and tumor response were analyzed as variables. The toxicity of the chemotherapy regimen (chemotox) was adjusted using MAX2 (Extermann et al., Eur J Cancer 2004). Results: We accrued 562 patients, 518 evaluable. 113 chemotherapy regimens/schedules were used. Cases were randomly split 2/3-1/3 into a derivation and a validation cohort. No common strong predictor was found for H and NH toxicity, except chemotox. So we designed the CRASH score along two subscores: H and NH. Predictors of H were albumin, IADL, LDH, DBP, and chemotox, with the 4 latter giving the best model. Predictors of NH were hemoglobin, CrCl, albumin, self-rated health, CIRS-G Severity Index, ECOG PS, MMS, MNA, and chemotox, with the 4 latter providing the best model. Numbers are below (max. 2 points/variable). Conclusions: The CRASH score offers a validated, clinically applicable mean of predicting significant differences in the risk of severe toxicity in older cancer patients starting a new chemotherapy. This provides a useful tool to individualize treatment choices on an objective basis. CRASH score (points/% with severe toxicity) Sample H subscore NH subscore Combined score Derivation (n = 347) 0-1: 7% 0-2: 33% 0-3: 50% 2-3: 23% 3-4: 46% 4-6: 58% 4-5: 54% 5-6: 67% 7-9: 77% >5: 100% >6: 93% >9: 79% Validation (n = 171) 0-1: 12% 0-2: 42% 0-3: 61% 2-3: 35% 3-4: 59% 4-6: 72% 4-5: 45% 5-6: 66% 7-9: 77% >5: 50% >6: 100% >9: 100% Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Pfizer, Roche, sanofi-aventis, Schering-Plough Amgen" @default.
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- W2244293385 date "2010-05-20" @default.
- W2244293385 modified "2023-10-14" @default.
- W2244293385 title "The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score: Design and validation." @default.
- W2244293385 doi "https://doi.org/10.1200/jco.2010.28.15_suppl.9000" @default.
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