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Clinical calculator summary

CARG-BC Breast Chemotherapy Toxicity Score

The eight-item breast-specific additive score grouping observed grade 3-5 chemotherapy toxicity in older adults with stage I-III breast cancer.

Evidence-based context for fast calculator use

Purpose:
Support neoadjuvant or adjuvant chemotherapy toxicity discussion alongside geriatric assessment
Population:
Adults age 65 years or older with stage I-III breast cancer receiving neoadjuvant or adjuvant chemotherapy
Factors:
Stage, Anthracycline-containing regimen, Treatment duration, Hemoglobin, Liver function, Falls, Walking more than one mile, Crisis-advice social support
Reference:
Magnuson et al., J Clin Oncol. 2021;39(17):1894-1902
HomeCARG-BC Breast Chemotherapy Toxicity
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CARG-BC Breast Chemotherapy Toxicity

Clinical Context & Background

CARG-BC is an 8-item breast cancer-specific additive score developed and validated for adults age 65 or older with stage I-III breast cancer receiving neoadjuvant or adjuvant chemotherapy. Its theoretical sum is 0-24, with low (0-5), intermediate (6-11), and high (12-24) groups.
In the validation cohort, observed grade 3-5 chemotherapy toxicity incidences were 27%, 45%, and 76% for the low, intermediate, and high groups. The corresponding development-cohort incidences were 19%, 54%, and 87%. These are group-level cohort observations, not individualized patient probabilities.
Use CARG-BC as a shared decision-making aid alongside recurrence risk, expected treatment benefit, comprehensive geriatric assessment, organ function, patient goals, and oncology/pharmacy review.
Formula Logic
Stage II/III +3; anthracycline-containing regimen +1; treatment duration >3 months +4; low hemoglobin +3; abnormal liver function +3; one or more falls +4; limited walking >1 mile +3; limited crisis-advice support +3. Sum 0-24.

Reference Data

Risk groupScoreValidation-cohort observed grade 3-5 toxicity incidence
Low Risk0-527%
Intermediate Risk6-1145%
High Risk12-2476%

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use before neoadjuvant or adjuvant chemotherapy when all eight source-defined responses are available.
  • Use only when the patient and clinical setting match the population described for CARG-BC Breast Chemotherapy Toxicity Score.

How To Interpret

  • Scores 0-5, 6-11, and 12-24 map to low, intermediate, and high groups. The displayed 27%, 45%, and 76% values are validation-cohort incidences, not individualized probabilities; development-cohort incidences were 19%, 54%, and 87%.
  • Interpret thresholds with the entered units, current clinical status, and local guideline context.

What To Do Next

  • Review recurrence risk, expected treatment benefit, comprehensive geriatric assessment, regimen options, supportive care, patient goals, and preferences together with the score.
  • Document the inputs, result, clinical judgment, and any reason for deviating from the model-guided pathway.

Limitations

  • Do not apply outside adults age 65 or older with stage I-III breast cancer receiving neoadjuvant or adjuvant chemotherapy, or use the score alone to omit treatment.
  • This calculator supports clinical assessment and does not independently prescribe treatment.

Validated Population

Adults age 65 years or older with stage I-III breast cancer receiving neoadjuvant or adjuvant chemotherapy

Clinical example

A score of 12 is in the high group and is contextualized by the observed validation-cohort incidence while decisions remain individualized.

Calculation verification history

Verified
  1. : Production browser revalidation

    • Three source-backed cases passed through all eight visible production controls at scores 0, 6, and 24.
    • Low, Intermediate, and High groups matched the 0-5, 6-11, and 12-24 boundaries with separately labeled validation- and development-cohort incidences.
    • No unexpected N/A, stale control, literal undefined value, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/carg-bc-breast-chemotherapy-toxicity-2026-08-03.json.

  2. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/carg-bc-breast-chemotherapy-toxicity.json.

  3. : Full validation test

    • Verified all 256 binary combinations, risk boundaries, trace reconciliation, strict missing/invalid-input rejection, no-default behavior, and exact UI serialization.
    • Labeled 27%/45%/76% as validation-cohort incidences and 19%/54%/87% separately as development-cohort incidences, never individualized probabilities.
  4. : Correction history

    • Corrected planned treatment duration over 3 months from +1 to the source-defined +4 and restored the full 0-24 score range.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

What is CARG-BC Breast Chemotherapy Toxicity Score used for?

Support neoadjuvant or adjuvant chemotherapy toxicity discussion alongside geriatric assessment. It is intended for adults age 65 years or older with stage i-iii breast cancer receiving neoadjuvant or adjuvant chemotherapy.

Does CARG-BC Breast Chemotherapy Toxicity Score determine treatment by itself?

No. Confirm the population, inputs, contraindications, competing risks, and current guideline recommendations before acting on the result.

Evidence-based oncology decision support. Verify with clinical guidelines.