TOTAL TUMOR MASS SCORE* & CUMULATIVE ILLNESS RATING SCALE for GERIATRICS**
PATIENTS' INFO
Patient:
Age:
Dg:
Calculated by:
TOTAL TUMOR MASS SCORE (TTM)
(*Jakšić B, Vitale B. Br J Haematol. 1981 Nov;49(3):405-13.)
WBC:
(x 10
6
/L) x % of total lymphoid cells
% =
TM1
=
TTM
beg
:
TM2:
(lymphnode in cm)
TTM:
TTM
end
:
DT:
TM3:
(spleen below LCA in cm)
TD:
M:
months
CUMULATIVE ILLNESS RATING SCALE for GERIATRICS (CIRS-G)
(**Miller, Paradis, Reynolds. 1991)
HEART: No problem (0)
HEART: Current mild problem or past significant problem (1)
HEART: Moderate disability or morbidity/requires „first line“ therapy (2)
HEART: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
HEART: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
CIRS-G RESULTS:
VASCULAR: No problem (0)
VASCULAR: Current mild problem or past significant problem (1)
VASCULAR: Moderate disability or morbidity/requires „first line“ therapy (2)
VASCULAR: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
VASCULAR: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
TOTAL NO. CATEGORIES ENDORSED:
HEMATOPOIETIC: No problem (0)
HEMATOPOIETIC: Current mild problem or past significant problem (1)
HEMATOPOIETIC: Moderate disability or morbidity/requires „first line“ therapy (2)
HEMATOPOIETIC: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
HEMATOPOIETIC: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
RESPIRATORY: No problem (0)
RESPIRATORY: Current mild problem or past significant problem (1)
RESPIRATORY: Moderate disability or morbidity/requires „first line“ therapy (2)
RESPIRATORY: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
RESPIRATORY: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
TOTAL SCORE:
EYES AND ENT: No problem (0)
EYES AND ENT: Current mild problem or past significant problem (1)
EYES AND ENT: Moderate disability or morbidity/requires „first line“ therapy (2)
EYES AND ENT: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
EYES AND ENT: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
SEVERITY INDEX:
UPPER GI: No problem (0)
UPPER GI: Current mild problem or past significant problem (1)
UPPER GI: Moderate disability or morbidity/requires „first line“ therapy (2)
UPPER GI: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
UPPER GI: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
No. of categories at level 3 severity:
LOWER GI: No problem (0)
LOWER GI: Current mild problem or past significant problem (1)
LOWER GI: Moderate disability or morbidity/requires „first line“ therapy (2)
LOWER GI: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
LOWER GI: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
LIVER: No problem (0)
LIVER: Current mild problem or past significant problem (1)
LIVER: Moderate disability or morbidity/requires „first line“ therapy (2)
LIVER: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
LIVER: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
No. of categories at level 4 severity:
RENAL: No problem (0)
RENAL: Current mild problem or past significant problem (1)
RENAL: Moderate disability or morbidity/requires „first line“ therapy (2)
RENAL: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
RENAL: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
GENITOURINARY: No problem (0)
GENITOURINARY: Current mild problem or past significant problem (1)
GENITOURINARY: Moderate disability or morbidity/requires „first line“ therapy (2)
GENITOURINARY: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
GENITOURINARY: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
MUSCULOSKELETAL/INTEGUMENT: No problem (0)
MUSCULOSKELETAL/INTEGUMENT: Current mild problem or past significant problem (1)
MUSCULOSKELETAL/INTEGUMENT: Moderate disability or morbidity/requires „first line“ therapy (2)
MUSCULOSKELETAL/INTEGUMENT: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
MUSCULOSKELETAL/INTEGUMENT: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
NEUROLOGICAL: No problem (0)
NEUROLOGICAL: Current mild problem or past significant problem (1)
NEUROLOGICAL: Moderate disability or morbidity/requires „first line“ therapy (2)
NEUROLOGICAL: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
NEUROLOGICAL: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
ENDOCRINE/METABOLIC AND BREAST: No problem (0)
ENDOCRINE/METABOLIC AND BREAST: Current mild problem or past significant problem (1)
ENDOCRINE/METABOLIC AND BREAST: Moderate disability or morbidity/requires „first line“ therapy (2)
ENDOCRINE/METABOLIC AND BREAST: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
ENDOCRINE/METABOLIC AND BREAST: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
PSYCHIATRIC ILLNESS: No problem (0)
PSYCHIATRIC ILLNESS: Current mild problem or past significant problem (1)
PSYCHIATRIC ILLNESS: Moderate disability or morbidity/requires „first line“ therapy (2)
PSYCHIATRIC ILLNESS: Severe/constant significant disability/“uncontrollable“ chronic problems (3)
PSYCHIATRIC ILLNESS: Extreamly severe/immediate treatment required/end organ failure/severe impairment in function (4)
