The Italian population is progressively aging, and cancer incidence increases with age. Older patients are at higher risk of frailty, a condition associated with adverse outcomes such as disability, falls, hospitalization, and mortality.

Key indicators of frailty include reduced balance, impaired physical activity, cognitive decline, and particularly sarcopenia, defined as the progressive loss of skeletal muscle mass and strength. After age 60, muscle mass decreases by 1.4-2.5% annually, while muscle strength declines by 15% between ages 60-70 and by up to 30% per decade thereafter.

Sarcopenia increases the risk of falls, fractures, hospitalization, and non-cancer-related death. In cancer patients, its prevalence ranges from 11% to 74% and is associated with poorer survival outcomes in both early and advanced disease stages.In clinical oncology practice, several tools are available to assess frailty, identify vulnerable patients, and personalize care, treatment, and supportive interventions.

Inclusion Criteria:

Inclusion criteria for patients with solid tumors:

• Cytological or histological diagnosis of lung cancer or gastrointestinal tract tumors (esophageal, gastric, intestinal, colorectal, pancreatic, and biliary tract cancers), mesothelioma.
• Age ≥ 70 years
• Patients deemed eligible, at the investigator's discretion, for first-line treatment including at least one chemotherapeutic agent
• Previous treatments (e.g., adjuvant therapy) are allowed if completed at least one year prior to randomization
• ECOG performance status 0, 1, or 2
• Written informed consent obtained

Inclusion criteria for patients with hematologic malignancies:

• Cytological or histological diagnosis of multiple myeloma or lymphoma
• Age ≥ 70 years
• Patients deemed eligible, at the investigator's discretion, for first-line systemic treatment
• ECOG performance status 0, 1, 2, or 3
• Written informed consent obtained

Exclusion Criteria:

• Brain metastases (in solid tumors)
• Symptomatic bone lesions (in solid tumors)
• Cardiac disease classified as NYHA class III or IV
• Current or prior prostate or breast cancer receiving hormonal therapy (GnRH agonists or antagonists, androgen inhibitors, estrogen inhibitors)
• Acute leukemia
• Patients with pacemakers or implantable cardioverter-defibrillators (ICD)

Patients who are about to initiate first-line treatment, or who have received a maximum of two cycles of therapy for advanced/metastatic disease or a hematologic malignancy, will be assessed for eligibility for study enrollment. The type of oncologic or hematologic treatment will be selected by the investigator according to good clinical practice and in accordance with national and international guidelines.