Madrid, 18 January 2024. Ageing is presented as the main individual risk factor for the development of cancer (1). In this demographic group means that Geriatrics is becoming increasingly important. For this reason, MD Anderson Cancer Madrid has just set up the Oncogeriatrics Service, the only private hospital in Spain to offer it, the aim of which is to incorporate this important figure in the oncological care of the patient from a multidisciplinary approach so necessary for the wellbeing of those affected.
"It is not the same to make a decision about the management of the same cancer in young patients as in older and possibly multi-pathological patients. In these cases, the assessment of a geriatrician with expertise in oncology is very important. We are the first private hospital to offer this service. In a centre like ours, where the multidisciplinary approach is its hallmark, Oncogeriatrics must form part of our daily work. This service is a milestone for our hospital," says Dr Santiago Gonzalez, Medical Director of MD Anderson Madrid.
According to Dr Andrea Sáenz de Tejada, Head of the MD Anderson Madrid Oncogeriatrics Unit, it is estimated that in 2030, 70% of tumours will be in patients over 65 years old (2). "Spain has one of the highest life expectancies, not only in Europe, but worldwide, so the importance of having oncogeriatric services is becoming increasingly evident. Given that the role of this service is expected to become increasingly important in the coming years, developing this service makes us a pioneering centre in this speciality," says Sáenz de Tejada.
Comprehensive geriatric assessment of elderly cancer patients
The aim of this service, says the doctor, is to carry out a Comprehensive Geriatric Assessment (CGA) in elderly cancer patients. The CGA consists of a global approach that includes an exhaustive analysis of the nutritional, functional/physical, cognitive, pharmacological, psychological and social areas. Possible comorbidities are also analysed for decision-making by the multidisciplinary team.
With this information, the specialist can establish individualised treatment for the patient, intervene in areas of vulnerability or fragility and minimise or treat the survivor's after-effects.
The ageing process appears in a very heterogeneous way. Each individual ages in a unique way. Even two 80-year-olds can have different physical, cognitive and frailty conditions as well as different functional reserves, "Our job is to carry out a comprehensive assessment of each patient to identify areas of vulnerability, work on them and collaborate with various specialists to establish a care and treatment plan tailored to the specific needs of each patient," continues Dr Sáenz de Tejada.
Up to 27% of patients have their initially proposed oncology treatment changed after the CGA.
Cancer treatments in older patients produce greater toxicity, dependence and death than in younger patients. "Thanks to CGA, we can predict toxicity and vulnerability to various drugs as well as possible complications that may arise. Survival can also be estimated. All this allows us to establish an individualised care plan for each patient. In fact, up to 27% of patients change their initially proposed cancer treatment after CGA," she points out.
In this respect, a CGA not only prevents over- and under-treatment and their side effects but also helps to uncover problems not evident in the usual medical history that may affect the outcome of cancer treatment and can be worked on.
The nutritional aspect is equally important given that, according to Sáenz de Tejada, 10-20% of undernourished patients die more from malnutrition than from the tumour itself (3). "The geriatrician can prescribe nutritional supplements and a specific diet for the patient.
"Patients with low muscle mass have a poorer prognosis, so any nutritional intervention must be accompanied by physical exercise," she explains.
"The essential premise is that the increase in the elderly population leads to a constant increase in the incidence of cancer. Ageing is a heterogeneous process and requires a holistic approach, as well as a multidisciplinary approach," continues the Head of the new Oncogeriatrics Unit, who assures that CGAs are essential to address the complexity of ageing to be able to offer each patient the oncological care and individualised treatment he/she needs.
References
- Instituto Nacional del Cáncer. Factores de riesgo: edad. Latest access: December 2023.
- Sociedad Española de Geriatría y Gerontología - CÁNCER. NEOPLASIAS MÁS FRECUENTES (María Victoria Farré Mercadé/Raquel Benavent Boladeras)
- Rodríguez Couso M. Intervenciones geriátricas en el mayor con cáncer basadas en la valoración geriátrica integral. Áreas de optimización: lo que el geriatra puede aportar al equipo multidisciplinar. Nutr Hosp 2020;37(N.º Extra 1):38-47