Chemotherapy Risk Assessment Scale for High Age Patients (CRASH)
Predicts individual risk of severe toxicity in the oncologic patients.
Refer to the text below the calculator for more information on this risk prediction model and its interpretation.
This is a prediction tool that assesses the individual risk of severe toxicity from chemotherapy in oncologic patients aged 70 and over. It consists of 7 individual variables, grouped as a chemotox risk item and under 2 subscores (hematologic and nonhematologic).
CRASH Score Interpretation
| Hematologic subscore | Nonhematologic subscore | Combined score | CRASH risk category |
| 0 – 1 | 0 – 2 | 0 – 3 | Low |
| 2 – 3 | 3 – 4 | 4 – 6 | Intermediate-low |
| 4 – 5 | 5 – 6 | 7 – 9 | Intermediate-high |
| >5 | >6 | >9 | High |
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CRASH items
This is a prediction tool that assesses the individual risk of severe toxicity from chemotherapy in oncologic patients aged 70 and over. It consists of 7 individual variables, grouped as a chemotox risk item and under 2 subscores (hematologic and nonhematologic).
| CRASH Items | Points | |
| Chemotherapy risk See chemotox table below* | 0 | 0 |
| 1 | 1 | |
| 2 | 2 | |
| Hematologic subscore | ||
| Diastolic blood pressure (mmHG) | ≤72 mmHg | 0 |
| >72 mmHg | 1 | |
| Instrumental Activities of Daily Living score (IADL) | 26 – 29 | 0 |
| 10 – 25 | 1 | |
| Lactate dehydrogenase (U/L) | 0 – 459 U/L | 0 |
| >459 U/L | 2 | |
| Nonhematologic Subscore | ||
| Eastern Cooperative Oncology Group (ECOG) Performance Status | 0 | 0 |
| 1 – 2 | 1 | |
| 3 – 4 | 2 | |
| Mini Mental Health Status | 30 | 0 |
| <30 | 2 | |
| Mini Nutritional Assessment | 28 – 30 | 0 |
| <28 | 2 | |
*Examples of toxicity of the chemotherapy regiment (Chemotox) values, from the original study Extermann 2012:
Score interpretation
The CRASH Score is calculated by the addition of the Hematologic Subscore and Nonhematologic Subscore, counting chemotherapy risk only once. Results are associated with a chemotoxicity risk category:
| Hematologic Subscore | Nonhematologic Subscore | Combined Score | CRASH Risk Category |
| 0 – 1 | 0 – 2 | 0 – 3 | Low |
| 2 – 3 | 3 – 4 | 4 – 6 | Intermediate-low |
| 4 – 5 | 5 – 6 | 7 – 9 | Intermediate-high |
| >5 | >6 | >9 | High |
About the original and validation studies
The CRASH predictive model was developed following a prospective, multicentric study by Extermann et al. on a cohort of 562 patients aged 70 and over. AEs were defined as grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity. Twenty-four individual parameters were analysed. Chemotox values were adjusted via an index system (the MAX2 index).
CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined one.
It has the advantage of systematically integrating both chemotherapy and patient risk for older patients.
Ortland et al. evaluated CARG and CRASH predictive performance on a cohort of 120 patients and found that the two models provided similar results for overall toxicity (CARG: Odds ratio per unit increase (OR) 1.266, P = .015; ROC-AUC 0.681, P = .010; combined CRASH: OR 1.337, P = .029; ROC-AUC 0.650, P = .032).
A recent study by Frelaut et al. on a cohort of 248 patients aged 70 and over with gastrointestinal, genitourinary, breast and other cancers compared the performance of CARG and CRASH scores in predicting risk of severe adverse events (AEs).
The researchers noted that the CARG and CRASH scores did not predict severe adverse events in this cohort.
However, multivariate analysis identified several independent predictors of severe AEs, including an ECOG performance status of 1-2, the presence of grade 3-4 comorbidities, and a MAX2 index of 1.
Additionally, the study found a higher risk of severe AEs in patients with non-colorectal gastrointestinal cancers, genitourinary cancers, breast cancer, and other types of cancer compared to those with colorectal cancer. Conversely, patients who were overweight or obese had a lower risk of experiencing severe AEs.
References
Original reference
Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ 3rd, Balducci L. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012 Jul 1;118(13):3377-86.
Validation
Ortland I, Mendel Ott M, Kowar M, et al. Comparing the performance of the CARG and the CRASH score for predicting toxicity in older patients with cancer. J Geriatr Oncol. 2020; 11(6):997-1005.
Frelaut M, Paillaud E, Beinse G, Scain AL, Culine S, Tournigand C, Poisson J, Bastuji-Garin S, Canoui-Poitrine F, Caillet P. External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort. Oncologist. 2023; 28(6):e341-e349.
Specialty: Oncology
Objective: Toxicity predictor
No. Of Items: 7
Year Of Study: 2012
Abbreviation: CRASH
Article By: Denise Nedea
Published On: September 25, 2024
Last Checked: September 25, 2024
Next Review: September 25, 2029