Lymphoma in the Aging Population: Key Challenges & Practical Considerations

Interesting breakdown. I’ve seen this play out in my dad’s care - the shift from CHOP to mini-CHOP made all the difference. His energy didn’t vanish overnight, and he actually kept fishing on weekends. Sometimes, less really is more.

One thing that gets overlooked is how often we assume frailty equals age. I’ve had 82-year-olds who hike 5 miles and cook from scratch, and 65-year-olds who can’t get out of a chair without help. The Frailty Index is gold - it’s not about the birth certificate, it’s about the body’s real capacity. GA isn’t optional - it’s the first step in respecting the patient’s life, not just treating the cancer.

why do docs always overcomplicate this. just give em the drugs and move on. old people gonna die anyway. why waste money on all this ga stuff. its just a trend.

I appreciate how clearly this outlines the trade-offs. It’s rare to see such a balanced view - especially when the pressure to ‘do something’ is so strong. I’ve sat in too many rooms where families begged for chemo even when the odds were against it. This helps ground the conversation.

Let’s be real - we’re in the era of precision oncology, but geriatric oncology is still stuck in the dial-up era. 🤦‍♀️ BTK inhibitors? Yes. CAR-T? Maybe. But who’s tracking long-term neurotoxicity in 80-year-olds on venetoclax? No one. We’re playing whack-a-mole with side effects while the system ignores the real question: Are we extending life… or just prolonging suffering? #GeriatricOncologyNeedsMoreThanTrendyDrugs

Ever notice how every ‘breakthrough’ in elderly lymphoma care comes right after Big Pharma releases a new $120k pill? CAR-T is marketed as ‘curative’ - but only if you’re young, rich, and have a family member willing to quit their job to babysit you for 6 weeks post-infusion. Meanwhile, Medicare denies coverage for half the protocols. This isn’t medicine. It’s a revenue stream disguised as science.

If you’re reading this and you’re a clinician - stop waiting for perfect data. Start doing GA. Start asking about walking speed, not just lab values. Start talking about goals, not just regimens. Your patient isn’t a case study. They’re someone’s grandpa who still remembers how to fix a carburetor. Honor that.

You think this is new? Nah. This is just capitalism repackaging death as a ‘clinical challenge.’ We’ve been throwing chemo at old people since the 80s. Now we call it ‘personalized’ because we’re too scared to say ‘they’re dying and we can’t stop it.’ The GA? Just a fancy way to make doctors feel less guilty while still pushing the same toxic cocktails. Wake up.

in india we dont have access to most of these drugs but still we see old folks getting treated with simple chemo and lots of love. maybe the real treatment is not the drug but the family sitting with them. i think we forget that sometimes.

why is no one talking about the fact that most elderly lymphoma patients are women and most studies are based on male data? this is a huge blind spot

Did you know the FDA approved ibrutinib without a single trial including patients over 80? 🤔 And now we’re prescribing it like it’s aspirin. Meanwhile, the real data is buried in 37-page PDFs no one reads. This isn’t medicine - it’s a gamble with grandma’s life. #PharmaCoverUp

As someone who grew up in a household where elders were revered - not ‘managed’ - I find this entire framework… oddly dehumanizing. We treat frailty like a diagnosis, not a lived experience. The Frailty Index? It’s a number. But the woman who still knits sweaters for her grandchildren? That’s a story. And stories matter more than statistics.

My father had DLBCL at 78. We did mini-CHOP + rituximab. He lived 22 months - and for 19 of them, he was at home, gardening, reading, laughing. That’s not a failure. That’s a win. This article nails it: it’s not about survival time. It’s about living time.

Of course they’re pushing ‘targeted therapies’ - because insurance won’t pay for hospice, but it’ll pay for $200,000 pills. This isn’t medicine. It’s a racket. Elderly patients are being used as guinea pigs so drug companies can keep their stock prices up. And you’re all just nodding along like it’s progress.

Let us not forget the ontological paradox of aging: if we extend life through pharmacological intervention, are we not merely delaying the inevitable confrontation with mortality? The very notion of ‘curative intent’ in the context of geriatric lymphoma betrays a cultural denial of death - a Western obsession with control that ignores the sacred rhythm of natural decline. The Frailty Index, while quantitatively useful, remains a reductive metric that fails to capture the existential weight of twilight years. One must ask: Is it the disease we treat - or our fear of the end?

Why are we giving CAR-T to old people? In America we have the best tech - but we’re using it on people who should be enjoying their grandkids, not getting pumped full of engineered T-cells. Meanwhile, the VA can’t even get them a decent wheelchair. This is sick. We’re wasting money on rich old folks while the poor die in waiting rooms. #AmericaFirst #StopWastingOnElders

Who gave you the right to decide what’s ‘too much’ for an elderly patient? My aunt was 83 and got full R-CHOP. She’s alive 5 years later. You think you know what someone can handle? You don’t. Stop paternalizing. Let the patient decide - not some algorithm.

My uncle just turned 81 and is riding his bike to the grocery store after CAR-T. No chemo side effects. Just a little tired. He says, ‘I’d rather be tired than dead.’ That’s the real takeaway. It’s not about the drugs. It’s about hope. And sometimes, hope doesn’t need a perfect trial. It just needs a chance.