{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:48:12Z","timestamp":1785739692562,"version":"3.56.0"},"reference-count":57,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Older adults with cancer are at increased risk of severe treatment-related toxicity. CARG, CRASH, and CARG-BC were developed as toxicity-risk prediction models, whereas G8 was developed as a geriatric screening instrument but has also been evaluated as a predictor of treatment-related toxicity. This study aimed to assess, separately for each instrument, the accuracy with which these tools identify older adults who develop severe chemotherapy-related toxicity. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Seven databases were searched through May 2026 for observational studies evaluating the predictive accuracy of the CARG, CRASH, CARG-BC and G8 tools in patients aged \u226565 years initiating chemotherapy. Pooled sensitivity and specificity with 95% confidence intervals (CIs) were calculated, and ROC curves were constructed. Risk of bias was assessed using QUADAS-2 and certainty of evidence was evaluated using GRADE. Results: Twenty-one studies were included, with an overall toxicity prevalence of 52.6%. CARG demonstrated a pooled sensitivity of 79.7% and specificity of 38.3% (AUC = 0.632). CRASH showed sensitivity of 86.9% and specificity of 68.2% (AUC = 0.866), but estimates were based on only four studies. CRASH hematological toxicity showed sensitivity of 75.9% and specificity of 53.1% (AUC = 0.694), with substantial heterogeneity. G8 yielded sensitivity of 69.5% and specificity of 41.5% (AUC = 0.666). CARG-BC showed sensitivity of 83.3% and specificity of 54.4% (AUC = 0.763), based on two breast cancer studies. Certainty of evidence ranged from low to very low. Conclusions: The instruments have distinct purposes and were not pooled against one another. CARG and G8 may be useful for initial risk screening, whereas CRASH showed a more balanced profile but remains supported by limited evidence. None should be used as a stand-alone basis to withhold or modify treatment.<\/jats:p>","DOI":"10.3390\/cancers18152478","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:17:40Z","timestamp":1785737860000},"page":"2478","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive Accuracy of Chemotherapy Toxicity Tools in Older Adults with Cancer: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9595-8876","authenticated-orcid":false,"given":"Edwin","family":"Aguirre-Milachay","sequence":"first","affiliation":[{"name":"Hospital Nacional Almanzor Aguinaga Asenjo, EsSalud, Chiclayo 14001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario J.","family":"Valladares-Garrido","sequence":"additional","affiliation":[{"name":"Escuela de Medicina Humana, Universidad Se\u00f1or de Sip\u00e1n, Chiclayo 14001, Peru"},{"name":"Oficina de Inteligencia Sanitaria, Red Prestacional EsSalud Lambayeque, Chiclayo 14001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nallely V.","family":"Chapo\u00f1an-Agip","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Cient\u00edfica del Sur, Lima 15001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1228-1941","authenticated-orcid":false,"given":"Nelson Luis","family":"Cahuapaza-Gutierrez","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Cient\u00edfica del Sur, Lima 15001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betzy C.","family":"Torres-Zegarra","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Cient\u00edfica del Sur, Lima 15001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2560-3943","authenticated-orcid":false,"given":"Milagros","family":"Diaz-Torres","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Humana, Universidad de San Mart\u00edn de Porres, Chiclayo 14001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7267-0204","authenticated-orcid":false,"given":"Darwin A.","family":"Le\u00f3n-Figueroa","sequence":"additional","affiliation":[{"name":"Unidad de Posgrado y Especializaci\u00f3n, Tecnolog\u00edas Avanzadas para la Salud con enfoque en Inteligencia Artificial, Bioinform\u00e1tica y TIC, Universidad Peruana Cayetano Heredia, Lima 15102, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4045-0260","authenticated-orcid":false,"given":"Fernando M.","family":"Runzer-Colmenares","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Cient\u00edfica del Sur, Lima 15001, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1516","DOI":"10.1634\/theoncologist.2019-0701","article-title":"Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study","volume":"25","author":"Feliu","year":"2020","journal-title":"Oncologist"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1158\/2159-8290.CD-21-1059","article-title":"Hallmarks of Cancer: New Dimensions","volume":"12","author":"Hanahan","year":"2022","journal-title":"Cancer Discov."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jgo.2019.08.015","article-title":"The Association between Social Support and Chemotherapy-Related Toxicity in Older Patients with Cancer","volume":"11","author":"Shahrokni","year":"2020","journal-title":"J. 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