Results of a recent study suggest that use of the Geriatric Screening (G8) and the Cancer and Aging Research Group (CARG) chemotherapy toxicity assessments are predictive of risks of early emergency room (ER)/hospitalization events and mortality in older patients with cancer. The study results were presented in a poster at the 2022 ASCO Annual Meeting by Amit Arora, MD, of Kaiser Permanente in Oakland, California, and colleagues.
Guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network suggest use of the G8 and CARG assessment tools in older patients prior to starting chemotherapy, Dr Arora and colleagues explained in their poster. High scores on these assessments are linked to toxicity risks with chemotherapy. An aim of the researchers’ study was to evaluate whether G8 and CARG scores can predict events of ER/hospital use and mortality.
Patients in this study were 65 years of age or older and were seen for newly diagnosed cancer at clinics within the Kaiser Permanente Northern California system. The G8 and CARG assessments were given to all patients, and they were followed for 30 or more days to evaluate ER/hospitalization events and mortality in order to analyze possible relationships between G8 and CARG scores and these outcomes. High-risk G8 scores were below 14 and high-risk CARG scores were 10 or higher.
The pilot study included 1082 patients who completed the G8 assessment and 516 patients who completed the CARG tool. High-risk CARG scores were more common among men (48%) than in women (39%; P =.012). However, ethnicity appeared to not be significantly associated with high-risk G8 or CARG scores.
There appeared to be relationships between increasing age and high-risk scores on both the G8 and CARG assessment tools. With the G8 tool, for example, 58% of patients younger than 70 years of age had a high-risk G8 score, 100% of those 90 years of age or older did, and the prevalence of high-risk G8 scores increased in age groups between these thresholds (P <.001). With the CARG tool, 19% of patients younger than 70 years of age had high-risk CARG scores, compared with 81% in the age group of patients 90 years of age or older (P <.001).
In an adjusted analysis of mortality, evaluating time to death, a high-risk G8 score was associated with a significantly higher risk of this outcome than a low-risk G8 score was (hazard ratio [HR], 4.52; 95% CI, 2.28-897; P <.0001). A similar pattern was seen for high-risk, versus low-risk, CARG scores (HR, 3.92; 95% CI, 1.21-12.74; P =.0230).
In an adjusted analysis of the risk of ER/hospitalization events, a high-risk G8 score was also associated with an HR of 1.58 (95% CI, 1.23-2.03; P =.0003) for this outcome compared with having a low-risk G8 score. With high-risk CARG scores, compared with low-risk, a similar pattern was also seen (HR, 2.42; 95% CI, 1.37-4.29; P =.0024).
The study investigators concluded that scores on these assessment tools were predictive of risks of early ER/hospitalization events and mortality in older patients with cancer.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
- Arora A, Sun H, Shaia JL, et al. Using G8 and CARG toxicity score to predict emergency room (ER) visits, hospitalizations, and mortality in older patients with newly diagnosed cancer. Presented at ASCO 2022; June 3-7, 2022. Abstract 12055.