Abstract
PURPOSE: This study aimed to evaluate whether the Cancer and Aging Research Group (CARG) score is suitable for assessing chemotherapy toxicity risk in older adults with cancer.
METHODS: Studies that enrolled older cancer patients undergoing chemotherapy and compared incidence of chemotherapy toxicity in three CARG score categories- low CARG (0-5), intermediate CARG (6-9), and high CARG (10-23), were identified using PubMed and EMBASE, as well as screening the references of reviewed studies. Studies that performed receiver operating characteristic (ROC) analysis and reported area under curve (AUC) were also included. A meta-analysis was conducted to calculate the risk ratio (RR) of ≥ grade 3 toxicity and integrate AUC.
RESULTS: Twenty-three studies published between 2019 and 2025 were included in our analysis with a total of 4,140 older patients who underwent various types of chemotherapy. Nineteen studies reported categorical results and 14 studies reported AUC. Higher CARG category patients had a significantly higher incidence of ≥ grade 3 chemotherapy toxicity than lower CARG category patients (Intermediate CARG vs. low CARG; RR [95% CI]: 1.26 [1.07-1.48], p = 0.006, I2 = 74%. High CARG vs. intermediate CARG; RR [95% CI]: 1.30 [1.15-1.46], p < 0.001, I2 = 67%. High CARG vs. low CARG; RR [95% CI]: 1.68 [1.32-2.15], p < 0.001, I2 = 86%.). Integrated AUC was 0.633 (95% CI: 0.558-0.709).
CONCLUSIONS: The CARG score is an effective tool for assessing the risk of ≥ grade 3 chemotherapy toxicity in older adults as part of geriatric assessment.