Use of G8 screening and CARG toxicity scores to predict emergency room (ER), hospital (IP) admissions, and mortality in newly diagnosed older patients with cancer undergoing chemotherapy with or without immunotherapy: Updated 3-year analysis.

Abstract

e13768 Background: National guidelines recommend that older patients undergo geriatric screening, G8 and CARG. In our initial six-month pilot at Northern California oncology clinics, high risk (G8 ≤14) and CARG (10-19) scores correlated with higher mortality and ER/IP admission in older adults with newly diagnosed cancer. We then extended this workflow to all Kaiser Northern California clinics. Methods: Patients 65 and above with new cancer diagnoses (Jan 2021–Dec 2024) completed G8 and CARG assessments. Monitored outcomes were ER/IP admissions and mortality. Associations between risk categories and demographics/utilization were tested using chi-square, while Cox models analyzed relationships between scores and time to ER/hospitalization or death. Results: A total of 2,684 patients completed G8, and 4,347 patients completed CARG. The proportion of patients classified as high risk by G8 or CARG increased with each decade of age (G8: < 70 years, 64%; 70–79 years, 65%; 80–89 years, 87%; ≥90 years, 100%; p < 0.0001; CARG: < 70 years, 13%; 70–79 years, 33%; 80–89 years, 53%; ≥90 years, 71%; p < 0.0001). High-risk CARG was more prevalent among men compared to women (33% vs. 29%, p < 0.0001). There was no significant association between ethnicity and high risk G8 or CARG. High risk CARG scores were noted in upper GI (42%), genitourinary (GU) (42%), and lower GI (43%) cancers patients. High risk G8 scores were prevalent in upper GI (85%), thoracic (70%), malignant hematologic (69%), and lower GI (66%) cancers. Both assessment tools demonstrated statistically significant differences among cancer types (p < 0.0001). The rates of mortality, ER/IP admission, and referral to hospice or palliative care increased at 180 days in both high risk G8 and CARG groups (p < 0.0001). Patients with high risk G8 or CARG scores had 3x the mortality rate, 1.4x the ER/IP admission rate, and over 2x as likely to be referred to palliative care or hospice compared to low risk patients. Conclusions: Our follow up analysis with an expanded sample size corroborates previous results, demonstrating that high risk scores on G8 and CARG assessments at initial cancer diagnosis are predictive of ER/IP admissions and mortality in older adults with cancer. These assessments should be incorporated into the initial oncology evaluation to inform shared treatment decision making. Hazard ratios for ER/IP admission and mortality comparing high/low risk G8 and CARG patients. Outcome HR 95% CI p-value High vs Low Risk CARG ER/IP 1.409 1.231- 1.613 <.0001 High vs Low Risk G8 ER/IP 1.332 1.201- 1.478 <.0001 High vs Low Risk CARG Mortality 2.208 1.761-2.769 <.0001 High vs Low Risk G8 Mortality 1.894 1.594-2.25 <.0001 Age, cancer type, and BMI also showed significance in determining outcomes.