Dr Alonso V. Pacheco Discusses a Tool to Measure Chemotherapy Toxicity for Elderly Patients

A tool to measure chemotherapy toxicity from the Cancer and Aging Research Group (CARG) can help determine emergency department visits or hospitalization risk, especially for elderly patients, says Alonso V. Pacheco, MD, medical director and medical oncologist/hematologist, Rocky Mountain Cancer Centers (RMCC).

Transcript

What is the CARG pilot?

The CARG pilot evolved out of a desire to improve the care of elderly patients. There is at least the question whether some patients were receiving chemotherapy that weren't benefiting from that. We looked at the [American Society of Clinical Oncology] guidelines at the time, and they recommended a geriatric assessment. We looked at several different geriatric assessments and one rose to the top, and that was the CARG Chemotherapy Toxicity Tool calculator. It's a mouthful, but it was developed by the Cancer Aging Research Group. I'll refer to as the CARG tool.

But the CARG tool is powerful. It can be done in 5 minutes, at the point of care with the patient. It allows the physician to aid in shared decision-making and, ultimately, helps the patient better understand what the risk of the chemotherapy they're about to receive is. It does that by predicting the risk of grade 3/4 toxicity, and you fall into 3 groups: low, intermediate or middle, or high. It's the high-risk patients that it’s been shown by Kaiser [Permanente] that it’s predictive of whether they'll experience [emergency department] visits or hospitalizations.

Along the way, we've tried to expand this tool to move from a group of early adopters that are using it. We partnered with Anthem to assign the evaluation and management code to it, and that ultimately allows us to track when this decision is being made, or when this intervention is happening. We can attach it to the visit; we can look back and track that code and then ultimately see what happened to that patient to date. What was their score, as documented in the note? Was their shared decision making that occurred at that time, as documented in the note? And whether that patient went on to receive therapy dose reduced or full dose? Or did they elect to forego chemotherapy and choose hospice instead? That's a very powerful decision point in the care of elderly patients with advanced cancers. I'd argue it's probably the most important decision point in the care of an elderly patient with advanced cancer.

We're excited about it. We've learned about it along the way. I joined the Cancer Aging Research Group as a member, and we're happy to share this amongst ourselves here at RMCC, but also amongst the broader group of US Oncology Network and also, nationally.