Older adults (OA, ≥65 years) with cancer are a heterogenous population, with higher risk of side effects from treatment, due to aging related decline in function, comorbidities, physiologic changes in organ function, greater risk of frailty, and social vulnerability [1,2]. They also often choose to prioritize quality of life and functional independence over prolonging life [1]. Therefore, management of cancer in OA requires individualization, while balancing risks and benefits from cancer directed therapy.

Malignancy and cardiovascular disease are leading causes of death in older adults [1]. An assessment of functional status has long been used to facilitate decision-making regarding initiation of chemotherapy and, for older adults, there are now guidelines to include geriatric or frailty assessments as part of the oncologic evaluation prior to chemotherapy initiation [2]. However, less is known about the association between frailty and outcomes in patients with cancer therapy-associated cardiotoxicity.