In 2022, Agustí Rovira, a resident of Valldoreix (Barcelona), became the first nonagenarian to receive a kidney transplant in Spain. Normally his candidacy would have been ruled out due to his age, but the specialists at the Clínic hospital concluded that the patient's good physical condition and the optimal condition of his arteries and blood vessels guaranteed the viability of the transplant. In the near future, the DNI will not be, as until now, the determining factor when deciding treatments, but rather the degree of fragility of the patients.
“There will be more and more older people with cancer because the population ages, treatments are more effective and lengthen life, and because diagnosis improves in various types of tumors,” contextualizes geriatrician Marco Inzitari, general director of the Parc Sanitari Pere Virgili (PSPV). "It's about not putting everyone in the same bag," he says. "Being older and having cancer does not mean that you have to throw in the towel or that you have to go all out with aggressive treatments. There are tools to decide the most appropriate treatment for each person regardless of their age or the type of cancer they suffer from."
The criterion is what the WHO defines as intrinsic capacity, the combination of physical and mental abilities that a person possesses at a given time. Since everyone who reaches old age and has morbidities will undergo a test to determine their level of frailty with a view to guiding the approach to their illnesses, it is important that the tests are not only accurate in terms of results, but also as quick and simple as possible.
In this sense, a study led by the PSPV and the Vall d'Hebron Research Institute (VHIR) concludes that a simple physical test that can be performed in less than ten minutes in any office and without the need for a doctor - nursing or physiotherapy staff can take charge perfectly - accurately identifies older people with cancer who have a higher risk of dying within a year, giving way to a more personalized approach to geriatric oncology.
A total of 229 patients over 6 years of age with lung, prostate, colorectal and other gastrointestinal cancers, both admitted to the hospital and treated in outpatient clinics, were evaluated using three different frailty assessment tools: SPPG, G8 and Frailty Index-VIG.
The researchers followed up for one year to determine the results. With similar predictions, the SPPB and the IF-VIG (normally used in primary care) showed greater predictive capacity than the G8 (specific tool for cancer), reinforcing their value as practical tools to support clinical decision making.
But while the IF-VIG is based on a more complete geriatric evaluation, which requires more time and resources, the SPPB is a simple evaluation based on balance, gait speed and muscle strength of the lower extremities.
This test “stands out for its combination of precision, speed and ease of use, which makes it an especially valuable tool for incorporating the assessment of frailty into routine clinical practice, especially when it is not possible to perform a comprehensive geriatric evaluation,” the researchers point out.
"In some cases the treatment can be more aggressive because there is a physiological reserve and the patient could live longer and with better quality and in other patients, even if they are younger, advanced cancer can cause aggressive treatment to cause poor quality of life and a more conservative approach oriented towards comfort is preferable. These tools are very useful when making decisions," says Inzitari, principal investigator of the Profit project, a European initiative financed by the Spanish Cancer Association and which also has the participation of Servei Andorrà. d'Atenció Sanitària, the Institut Català d'Oncologia (ICO) in Girona and the University Hospital of Navarra.
