Association between chemotherapy toxicity risk scores and physical symptoms among older Brazilian adults with cancer

Objective: Utilizing the Cancer and Aging Research Group (CARG) chemotherapy toxicity risk score before starting treatment in older adults with cancer is guideline-recommended. However, this has not been tested in most developing countries. We investigated the use of a Portuguese version of the CARG score, including the association between this score and physical symptoms, among older Brazilian adults with cancer.

Patients and methods: We enrolled patients aged ≥65 starting chemotherapy at a public Brazilian hospital. A Portuguese version of the CARG tool was created and linguistically validated. Patients were assessed for chemotherapy toxicity risk using the CARG score, and physical symptoms were evaluated using the Functional Assessment of Cancer Treatment-General (FACT-G) scale. Multivariable logistic regression was used to identify physical symptoms associated with high CARG scores, including pain, nausea, and fatigue.

Results: Older patients (65+) with cancer were enrolled (n = 117). Patients were mostly female (57.3%), white (52.1%), married (52.1%), and had less than high school education (75.2%). Breast, gastrointestinal and lung cancers were the most common diagnosis, and 66.7% had metastatic disease. Elevated pain scores (P < .01) were associated with higher chemotherapy toxicity risk scores, even after adjusting for potential confounders.

Conclusion: We created and implemented a Portuguese language version of the CARG tool. We found that, although physical symptoms are not included in the CARG model, elevated pain was strongly associated with having a high CARG score. As a modifiable risk factor, pain should be addressed among older patients with cancer considering chemotherapy, to help mitigate their risks for toxicity.