Chemo-Toxicity Calculator

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Patient’s Age

Patient’s Height

Patient’s Weight

Cancer Type

Dosage *

Number of Chemotherapy Agents


How is your hearing (with a hearing aid, if needed)?

Number of falls in the past 6 months

Can you take your own medicines?

Does your health limit you in walking one block?

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

Select Serum Creatinine

Creatinine Clearance **

Toxicity Score

Risk of Chemotherapy Toxicity

* Dose delivered with first dose for chemotherapy

** Jeliffe formula


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