Diffuse large B-cell lymphoma (DLBCL) patients have a median age of 70 years. Yet, empirical knowledge on treatment for older patients is limited as they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older, real-world DLBCL population. All patients ≥70 years diagnosed with DLBCL 2006-2016 in south-eastern Norway (n=784) were included retrospectively, and divided into a training (n=522) and validation cohort (n=262). We constructed and validated a frailty score based on geriatric assessment variables, and examined survival and TRM according to frailty status and treatment. The frailty score identified three frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival (OS) fit 82%, unfit 47%, frail 14%, P<0.001). For fit patients, full-dose R-CHOP (initial dosage>80%) was associated with better survival than attenuated R-CHOP (2-year OS 86% vs 70%, P=0.012), also in adjusted analysis. For unfit and frail patients, full-dose R-CHOP was not superior to attenuated R-CHOP, while an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with higher risk of death and TRM, which can aid treatment intensity decisions in older DLBCL patients. In this study, fit patients benefit from full-dose R-CHOP, while unfit and frail patients have no benefit of full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/.

BackgroundThe global population is ageing, and age is an important risk factor for cancer. The median age at diagnosis in Norway is about 70 years, and the number of older patients with cancer is rapidly increasing. The older population exhibit a large variety in general health status, and chronologic age is a poor marker for biologic age. Many older adults live with frailty, a condition characterised by depleted physiological and functional organ reserves leading to increased vulnerability to stressors. Geriatric assessment (GA) is a systematic evaluation of domains where older adults commonly have problems such as comorbidity, polypharmacy, nutritional status, physical function, functional status, and psychosocial function. Performing GA to identify patients' vulnerabilities and reserves is strongly advocated, although seldom applied in oncology practice. Approximately 50% of patients with cancer will need radiotherapy (RT) at some point during the disease trajectory. Older patients may prioritise preserved quality of life (QoL), physical function, and independency over limited survival benefits. However, little is known about how RT influences these outcomes in older patients with cancer. AimWe aimed to investigate the prevalence of age-related health problems and the development in cognitive function, in a cohort of older patients with cancer receiving RT with curative or palliative treatment intent and to assess the impact of age-related health problems on overall survival (OS), global QoL and physical function. MethodsA single centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) including comorbidities, medications, nutritional status, basic and instrumental activities of daily living (IADL), mobility, falls, cognition and depressive symptoms using recommended and validated tools. The mGA was repeated at RT completion, and two, eight and sixteen weeks later. At the same time points, patients reported global QoL and physical function (PF) by the European Organisation for Research and Treatment of Cancer Quality of Life Core questionnaire (QLQ-C30). Impairments in each mGA domain were defined based on recommended cut-points. OS was presented by Kaplan Meier plots for groups defined according to number of geriatric impairments and compared using the log-rank test. The

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