The patient’s frailty, not age, will determine medical treatments

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 discarded due to age, but specialists at the Clínic hospital concluded that the patient’s good physical condition and the optimal state of his arteries and blood vessels guaranteed the viability of the transplant. In the near future, the ID card will no longer be, as it has been until now, the determining factor when deciding treatments, but rather the degree of frailty of the patients.

Read more The president of Ceuta attacks the Government again and threatens to go to the judiciary

“There will be more elderly people with cancer because the population is aging, treatments are more effective and extend life, and because diagnosis improves in several types of tumors,” explains geriatrician Marco Inzitari, general director of the Parc Sanitari Pere Virgili (PSPV). “It is about not putting everyone in the same basket – he specifies –. Being old and having cancer does not mean either giving up or going 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 have.”

The criterion is what the WHO defines as intrinsic capacity, the combination of physical and mental capacities that a person has at a given moment. Since everyone who reaches old age and has morbidities will undergo a test to determine their level of frailty in order to guide the approach to their diseases, it is important that the tests are not only accurate in terms of results but also as quick and simple as possible.

In this regard, a study led by the PSPV and the Vall d’Hebron Institut de Recerca (VHIR) concludes that a simple physical test that can be performed in less than ten minutes in any clinic and without the need for a doctor – nursing or physiotherapy staff can perfectly handle it – accurately identifies elderly people with cancer who have a higher risk of dying within a year, leading to a more personalized approach to geriatric oncology.

A total of 229 patients over 6 years old with lung, prostate, colorectal tumors and other gastrointestinal cancers, both hospitalized and attended in outpatient clinics, were evaluated using three different frailty assessment tools: SPPG, G8, and Frailty Index-VIG.

The researchers conducted a one-year follow-up to determine outcomes. With similar predictions, the SPPB and IF-VIG showed greater predictive capacity than the G8 (commonly used in primary care), reinforcing their value as practical tools to support clinical decision-making.

Read more Trump attributes the reduction of military maneuvers with Seoul to his relationship with Kim Jong Un

But while the IF-VIG is based on a more comprehensive geriatric assessment, which requires more time and resources, the SPPB is a simple evaluation based on balance, walking speed, and lower limb muscle strength.

This test “stood out for its combination of accuracy, speed, and ease of use, making it an especially valuable tool to incorporate frailty assessment into routine clinical practice, especially when a comprehensive geriatric assessment is not possible,” the researchers point out.

“In some cases, treatment can be more aggressive because there is physiological reserve and the patient could live longer and with better quality, and in other patients, even if younger, advanced cancer may cause aggressive treatment to result in poor quality of life and a more conservative approach focused on comfort is preferable. These tools are very useful when making decisions,” specifies Inzitari, principal investigator of the Profit project, a European initiative funded by the Spanish Association Against Cancer and also involving the Servei Andorrà d’Atenció Sanitària, the Institut Català d’Oncologia (ICO) in Girona, and the University Hospital of Navarra.

The work has been published in The Journals of Gerontology: Series A . Oncology is not the only field converging with geriatrics (oncogeriatrics) to adapt treatments to the needs and goals of each person. The convergence is increasing in cardiology (cardiogeriatrics) or traumatology (traumageriatrics), among other specialties. The assessment of intrinsic capacity, or frailty, is, in this sense, a growing need.