Extermann et al developed the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) Score for identified an older patient at risk for severe toxicity associated with chemotherapy. The authors are from Moffitt Cancer Center, University of South Florida, Duke University, and several community hospitals in Florida.
Patient selection: age >= 70 years
Outcomes: severe hematologic (Grade 4) or non-hematologic (Grade 3 or 4) toxicity
Parameters:
(1) diastolic blood pressure
(2) Instrumental Activities of Daily Living (IADL)
(3) ratio of serum LDH to upper limit of normal
(4) ECOG performance status
(5) Mini-Mental Health Status (MMS)
(6) Mini-Nutritional Assessment (MNA)
(7) relative toxicity of the chemotherapy regimen (low, intermediate, high based on Chemotox)
Scores for hematologic toxicity
|
Parameter |
Finding |
Points |
|---|---|---|
|
diastolic blood pressure |
<= 72 mm Hg |
0 |
|
|
> 72 mm Hg |
1 |
|
IADL |
10 to 25 |
1 |
|
|
26 to 29 |
0 |
|
LDH ratio |
<= 0.74 |
0 |
|
|
> 0.74 |
2 |
|
relative toxicity |
low (< 0.44) |
0 |
|
|
intermediate (0.45 to 0.57) |
1 |
|
|
high (> 0.57) |
2 |
score of hematologic toxicity =
= SUM(points for the 4 parameters)
Scores for non-hematologic toxicity
|
Parameter |
Finding |
Points |
|---|---|---|
|
ECOG performance |
0 |
0 |
|
|
1 or 2 |
1 |
|
|
3 or 4 |
2 |
|
MMS |
< 30 |
0 |
|
|
30 |
2 |
|
MNA |
< 28 |
0 |
|
|
28 to 30 |
2 |
|
relative toxicity |
low |
0 |
|
|
intermediate |
1 |
|
|
high |
2 |
score of nonhematologic toxicity =
= SUM(points for the 4 parameters)
Interpretation:
• minimum hematologic or non-hematologic score: 0
• maximum hematologic score: 6
• maximum nonhematologic score: 8
|
Hematologic Score |
Risk of Severe Toxicity |
|---|---|
|
0 or 1 |
low |
|
2 or 3 |
low-to-moderate |
|
4 or 5 |
moderate-to-high |
|
6 |
high |
|
Non-hematologic Score |
Risk of Severe Toxicity |
|---|---|
|
0 to 2 |
low |
|
3 or 4 |
low-to-moderate |
|
5 or 6 |
moderate-to-high |
|
7 or 8 |
high |
Performance:
• The performance of the individual scores was better than if they were combined.
Purpose: To identify an older adult who is at risk for severe adverse reaction to chemotherapy using the CRASH score of Extermann et al.
Specialty: Hematology Oncology, Pharmacology, clinical
Objective: risk factors, response to therapy, adverse effects
ICD-10: T88.7,
