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Background: Aggressive non-Hodgkin lymphoma (aNHL) commonly occurs in older adults. However, geriatric assessments (GAs), which are associated with both survival and treatment-related toxicity, are infrequently performed due to logistical constraints. In this study, we examined how the brief, self-reported Vulnerable Elders Survey-13 (VES-13) screening tool and a comprehensive GA relate to clinical outcomes in this population. Methods: We conducted a longitudinal study of 105 adults aged ≥65 years who were initiating upfront chemoimmunotherapy for aNHL at 2 academic medical centers and their community affiliates between September 2020 and January 2023. Baseline frailty was evaluated using the Fondazione Italiana Linfomi (FIL) GA, which classifies patients as fit, unfit, or frail. The VES-13 was assessed both continuously and by categorizing patients as vulnerable (score ≥3). Using logistic regression controlling for covariates, we examined the association of VES-13 with grade ≥3 nonhematologic toxicity (toxicity), unplanned hospitalization within 6 months of treatment initiation, decline in quality of life (QoL) 1 year after therapy initiation, and death within 1 year of treatment initiation. In addition, we calculated the sensitivity and specificity of both the VES-13 and the FIL GA in identifying patients at risk for these outcomes. Results: The median patient age was 73 years (range, 64–99 years), with 42% aged ≥75 years. GA classified 40% of patients as fit, 10% as unfit, and 51% as frail, while 46% of patients had a VES-13 score ≥3, indicating vulnerability. VES-13 score was significantly associated with toxicity (odds ratio [OR], 1.18; P =.026), unplanned hospitalization (OR, 1.16; P =.043), QoL decline at 1 year (OR, 1.22; P =.027), and death within 1 year (OR, 1.49; P =.010). Using the VES-13 to define vulnerability (score ≥3), sensitivity and specificity were 59% and 61% for predicting toxicity, and 100% and 59% for predicting death within 1 year, respectively. FIL GA frailty had a sensitivity of 63% and specificity of 56% for predicting toxicity, and 100% sensitivity and 54% specificity for predicting death within 1 year. Conclusions: We found that VES-13 score was associated with survival, toxicity, health care utilization, and QoL decline, demonstrating similar sensitivity and specificity to the FIL GA. These findings underscore the potential utility of VES-13 as a screening instrument to identify older patients with aNHL at risk for adverse clinical outcomes.

Abstract Introduction Chronic orchialgia is a common urologic complaint, and is estimated to make up 2.5 to 5% of urology clinic consultations. Hyperactive cremaster reflex is an often under-diagnosed source of chronic testicular pain, wherein patients experience vigorous muscular retraction of the testicles up to the external inguinal ring. This has been related to possible anatomic thickening of the cremaster muscles, or an attenuated external oblique aponeurosis. Objective To report a unique etiology and subsequent treatment of chronic orchialgia. Methods We present a case of an individual who developed new onset of hyperactive cremaster reflex after hamstring and rectus abdomonis tear during a sporting injury. Results Patient is a 37-year-old male who presented with new onset of bilateral testicular pain and chronic testicular retraction. 6 weeks prior to presentation, while playing soccer, he sustained a complete tear in the right hamstring, and partial tearing of the right rectus abdominis-adductor aponeurosis at the pubic symphysis. He completed conservative therapy with heat and ice, an extended course of anti- inflammatory medications, and physical therapy without relief. On exam, testicles were bilaterally high riding, and cremasteric muscles were noted to be in tonic spasm. Testicles would be brought into the scrotum, but were noted to rapidly ascend. He was offered injection of neuromodulator into the cremasteric muscles versus bilateral microsurgical cremaster release, and opted for the latter treatment. Bilateral cremasteric muscle fibers were ligated and excised from the external ring down to the testicle proper, and testicles were pexied in place. At follow-up, he reported complete resolution of pain and tonic retraction. Testicles were found to have normal anatomic lie within the dependent portion of the scrotum. Conclusions In patients with chronic testicular pain refractory to conservative measures, the cremasteric muscles may play a role in potentiating pain signaling through chronic, unprompted muscular spasm. This should especially be considered after regional musculoskeletal injuries affecting pelvic and inguinal muscle groups. In this select group of patients, excision of the cremasteric muscles to release cremasteric tension may be a viable treatment option for resolution of chronic pain. Disclosure No