Background/Objectives: Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its predictive power. We aimed to assess the impact of pre-treatment frailty stratification on overall survival (OS) and acute radiation-related toxicity in a cohort of older patients with HNSCC. Methods: A prospective cohort of 117 patients aged ≥65 years with newly diagnosed HNSCC was enrolled between 2017 and 2022. Patients received RT with or without chemotherapy. Frailty was assessed using the 40-item Frailty Index (FI) as part of a comprehensive geriatric assessment. The primary outcomes were OS and acute RT toxicity, defined as a grade ≥ 3 based on CTCAE 5.0. Cox proportional hazard models and logistic regression models, adjusted for age, tumor stage, and chemotherapy, were used. Results: After a median follow-up of 819 days, FI (HR 1.478, 95% CI 1.182–1.848, p < 0.001) was an independent predictor of OS. Grade ≥ 3 toxicities were observed in 38% of patients, but frailty was not significantly associated with toxicity. A sub-analysis of oropharyngeal carcinoma patients demonstrated improved OS in HPV-positive patients (HR 0.231, 95% CI 0.078–0.686, p = 0.008). Conclusions: the standardized introduction of frailty assessment in the evaluation of older HNSCC patients holds great promise for predicting long-term survival. This approach could be crucial in tailoring treatment protocols that account for the biological heterogeneity of older adults.

Background: The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients’ fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem. Methods: This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021. Results: The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty. Conclusions: The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.

Background/Objectives: Multiple myeloma (MM) is a plasma cell neoplasm predominantly diagnosed in older adults. However, the significance of defining patient frailty, as well as identifying the most suitable and reliable tools for its assessment, remains to be firmly established. Methods: This retrospective observational study investigated 36 patients aged 65 or older who underwent Comprehensive Geriatric Assessment (CGA). The average patient age was 76 (SD 6.22), with 33.3% being female. Patients were evaluated using the International Myeloma Working Group Frailty Index (IMWG-FI) and the 40-item Rockwood’s Frailty Index (FI) at the Oncogeriatrics clinic of the IRCCS Polyclinic San Martino Hospital, Genoa, Italy between December 2017 and August 2021. Laboratory, cancer-specific, demographic, and clinical variables were collected. Survival analysis and frailty comparison were conducted using Stata version 17.0. Results: Stepwise multivariate analysis identified the Numerical Rating Scale (NRS) (HR 1.40, 95% CI 1.09–1.78, p = 0.008) and Rockwood’s Frailty Index (FI) (HR 2.23, 95% CI 1.29–3.87, p = 0.004) as significant prognostic predictors, adjusted for sex, ISS stage, and multimorbility. Comparison between Rockwood’s FI and IMWG-FI using Spearman correlation coefficient showed no statistically significant correlation (r = 0.268, p = 0.114). Multivariate Cox model, adjusting for sex, International Staging System (ISS) stage, and Cumulative Illness Rating Scale (CIRS) comorbidity index demonstrated the superior predictive ability of Rockwood’s FI over IMWG-FI (C-index 0.775 vs. 0.749). Conclusions: The 40-item Rockwood FI emerges as a valuable tool for prognostication in old MM patients, demonstrating non-inferiority to the traditional IMWG-FI in predictive accuracy, emphasizing the importance of a comprehensive approach considering both disease-specific and patient-related factors.