CARG-BC Calculator (Cancer and Aging Research Group Chemotherapy Toxicity Tool)
Predicts chemotoxicity side-effects of grade ≥3 in breast cancer elderly patients.
Refer to the text below the calculator for more information about this prediction model and its interpretation.
CARG-BC has been specifically developed for patients with early-stage breast cancer and aims to provide more accurate risk of chemotoxicity (grades 3-5) estimation than the more general CARG-TT tool.
The table below outlines these categories and the corresponding toxicity risk for each score.
| CARG-BC Score | Risk Category | G3-5 Toxicity Risk* |
| 0 – 5 | Low | 27% |
| 6 – 11 | Medium | 45% |
| >12 | High | 76% |
* Chemotherapy-related toxicities: Grade 3 = severe; Grade 4 = life-threatening; Grade 5 = fatal.
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Steps on how to print your input & results:
1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.
2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.
Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.
CARG-BC items
The Cancer and Aging Research Group Chemotherapy Breast Cancer estimates the risk of severe (grade 3 or greater) chemotherapy-related side effects in oncology patients aged >65.
CARG-BC has been specifically developed for patients with early-stage breast cancer and aims to provide more accurate risk estimation than the more general CARG-TT tool.
The 8 independent risk predictors and their individual scores are summarised below:
| CARG-BC Items | Points | |
| Breast cancer stage | II or III | 3 |
| I | 0 | |
| Planned use of anthracyclines | Yes | 1 |
| No | 0 | |
| Planned treatment duration | >3 months | 1 |
| ≤3 months | 0 | |
| Haemoglobin | ≤12 g/L (female) | 3 |
| ≤13 g/L (male) | 3 | |
| >12 g/L (female) | 0 | |
| >13 g/L (male) | 0 | |
| Liver function tests | Abnormal LFTs, outside reference range | 3 |
| Normal LFTs, within reference range | 0 | |
| Number of falls in last 6 months | One or more | 4 |
| None | 0 | |
| Does patient’s health limit them walking more than 1 mile? | Yes | 3 |
| No | 0 | |
| How often is someone available to give patient advice about a crisis | None, little, or some of the time | 3 |
| Most or all of the time | 0 | |
CARG-BC was found to outperform the original CARG tool and also Karnofsky performance status in patients with early stage breast cancer.
Scoring the CARG-BC
CARG-BC scores are calculated by adding the individual scores from the 8 items, with a total score ranging from 0 to 21. Higher scores indicate a greater risk of experiencing toxicity-related side effects. Patients are classified into three risk categories: low, medium, and high risk of toxicity. The table below outlines these categories and the corresponding toxicity risk for each score.
| CARG-BC Score | Risk Category | G3-5 Toxicity Risk* |
| 0 – 5 | Low | 27% |
| 6 – 11 | Medium | 45% |
| >12 | High | 76% |
* Chemotherapy-related toxicities: Grade 3 = severe; Grade 4 = life-threatening; Grade 5 = fatal.
About the original study and validations
Magnuson et al. prospectively evaluated a cohort of 473 patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions (283 in the development and 190 in the validation cohorts) treated with neoadjuvant or adjuvant chemotherapy, for features predictive of grade 3-5 chemotherapy toxicity.
Logistic regression with best-subsets selection was used to identify 8 independent predictors of toxicity, that were further incorporated into a model with weighted variable scoring.
The predictive performance of the model was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics.
The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity (P < .01).
References
Original reference
Magnuson A, Sedrak MS, Gross CP, et al. Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2021; 39(6):608-618.
Specialty: Oncology
Objective: Toxicity predictor
No. Of Items: 8
Year Of Study: 2021
Abbreviation: CARG-BC
Article By: Denise Nedea
Published On: September 25, 2024
Last Checked: September 25, 2024
Next Review: September 25, 2029