CARG Chemotherapy Toxicity Tool Helps Patients Understand Risks, Says Dr Alonso V. Pacheco

Patient quality of life can be improved through shared knowledge between doctors and patients in cancer care using the Cancer and Aging Research Group (CARG) Chemotherapy Toxicity Tool calculator, which Rocky Mountain Cancer Centers piloted, explained Alonso V. Pacheco, MD, medical director and medical oncologist/hematologist, Rocky Mountain Cancer Centers.

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How does the CARG pilot better incorporate patient shared decision making and improve outcomes?

I think there's 2 things that are happening when you're asking the questions that contribute to the CARG tool. Whether the patients had a fall in the last 6 months? Can they take their own medications with help or all by themselves? Can they walk a block with no limitations or a lot and whether their physical or emotional problems have impaired their ability to visit with friends or family? Those are all important questions to patients, and I think it allows them to gain a little introspection about their disease state and how their health currently is.

Then, the tool using several objective findings, like their hemoglobin and their creatinine, and their age and weight and height, it calculates a score and it's low, intermediate, or high, and high-risk patients are predicted to have increased hospitalizations and [emergency department] visits, and that's ultimately what we're trying to prevent. Those are the avoidable admissions that contribute to a lot of avoidable costs in cancer care.

Another thing’s happening. With that shared decision-making at the point of care of the patient, patients are electing and their providers are electing to, in appropriate cases, forgo chemotherapy because the risk is too high. Patients understand that and instead choose hospice and have an opportunity to thrive on hospice having never received chemotherapy, which is quite powerful. They have an opportunity to dose reduce, and that's done with that shared decision-making with their physician, and that can happen at the first dose. And maybe the patient experiences less toxicity. The tool can help with that. One way to use it is to do the tool for full dose versus dose reduction, and you see kind of what the risk is, in those 2 scenarios: does it go from high to medium? And that's a valuable decision point that I think patients really benefit from.

In my own practice, I've seen less hospitalizations because I use this tool regularly or on every patient in this age group now.

What are the current shortcomings of CARG?

It's not validated for targeted or oral therapy or palliative immunotherapy or immunotherapy, and I think that's one thing that is a shortcoming, especially in the era where there's more targeted and more immunotherapy being used in this age group. In my experience, it still has some value, asking those questions. Sharing the result of the CARG tool with the patient has some value in at anecdotal experience and Dr [William] Dale at City of Hope has conferred that he also has experienced this, is that patients with a high CARG score may not benefit from palliative immunotherapy as well, even if it's likely to help that disease site, or they have predictive markers that show that it's likely to help. I think that's powerful.

I think it's a next step, whether this tool is validated in that space as well. Or in those disease sites for that treatment as well. And something we can look into in the future.