Val d’Hebron expands its hematogeriatric oncology program

The model of oncogeriatric consultations for patients with breast cancer at the Val d’Hebron University Hospital, which began in 2021, has been extended to other types of cancer: colon and rectal cancer, lung cancer, bladder cancer, prostate cancer and hematological cancers such as cancer lymphoma and myeloma. The new hematogeriatric oncology program addresses the triple challenge of an aging population, increasing incidence of cancer in older patients, and increasing complexity of its treatment. “Approximately half of new cancer cases are diagnosed in older people, and we expect this number to increase in the future. As a tertiary care hospital we must respond to this health problem.”– explains Dr. Antonio San José, coordinator of oncogeriatrics in Val d’Hebron. “Intervening on the fragility of these patients and knowing the other comorbidities they may present, as well as their social and family context, is essential to fully personalize oncology treatment, adjust its toxicity and improve effectiveness.”– adds Dr. Gabriela Carrizo from the geriatric service of Val d’Hebron.

A total of 332 women underwent oncogeriatric consultation for breast cancer patients from April 2021 to March 2024. In 2021 alone, Val d’Hebron specialists made 203 new diagnoses of colon and rectal cancer, 156 new diagnoses of lung cancer, 22 myelomas and 25 lymphomas in patients over 70 years of age. “With the expansion of the Val d’Hebron oncohematogeriatrics program, we are following international recommendations: the collaboration of oncologists and geriatricians is essential for older cancer patients to assess their fragility and adjust the treatment, which improves in terms of adherence, tolerability and effectiveness”, explains Dr. Francesc Salva from the Colon Cancer Unit of Val d’Hebron. The aging population is one of the determining factors in the increase in the incidence of colon cancer in recent years. Aging also means longer exposure to environmental triggers such as tobacco, alcohol, lack of exercise, obesity and a diet rich in red meat and processed foods.

Geriatric examination of all cancer patients over 80 years of age.
The new hematogeriatric oncology program provides geriatric screening for all patients aged 80 years and older with colorectal cancer, lung cancer, breast cancer, bladder cancer, prostate cancer and hematological cancer. For patients aged 70 to 79 years, if they have a positive frailty screening test, if the nurse supervising the tumor in question deems it appropriate and at the discretion of the physician responsible for the patient. In addition, the new hematogeriatrics oncology program involves integrating a group of geriatricians into the committees for each of the selected tumors to convey their first-hand assessment before deciding on hematologic oncology treatment for each patient and to ensure that it is based on physiological reserve and not on the chronological age of the patient. A comprehensive geriatric assessment includes the degree of frailty, degree of comorbidities, cancer-free life expectancy, and risk of complications from cancer treatment. Based on the assessment, the committee decides for each of the selected tumors whether the patient can tolerate standard treatment, requires intervention for reversible disorders and preliminary rehabilitation before receiving oncological treatment, or whether the most appropriate treatment is primarily symptomatic.

Oncogeriatric nurse needed for consultation

Oncogeriatric consultations involve a nurse from the medical oncology service and doctors from the geriatrics service of each oncology specialty. The patient’s first visit is carried out by a nurse who carries out a comprehensive geriatric assessment, including various scales in which his condition is assessed in all areas (functional, cognitive, social, nutritional…), and not just in the medical field. “The nurse provides health education based on an individualized treatment plan and always taking into account the interests and priorities of the patient. Particular attention is paid to issues such as nutrition and exercise, as this is where frailty can be reversed. In addition, it controls tolerance to cancer treatments.”– sums up Carolina Martinez, a nurse in the oncogeriatric department. “Emotional support is provided throughout the process for these patients, who usually come to consultation very upset. When deficiencies are identified that we cannot treat, we refer them to specialists who support us in the fields of social work, psychology, nutritional support or rehabilitation. In this way, we try to prevent or restore cancer-related decline to mitigate possible deficits.”.

“With oncogeriatric screening, we will better outline the treatment our patients aged 70 years and older receive. “This is important in lymphoproliferative syndromes and myelomas to improve quality of life and ensure maximum treatment efficacy with minimal toxicity.”, explains Dr. Merce Gironella from the Val d’Hebron Hematology and Hemotherapy Service. The Nutrition Services Department, Physical Medicine and Rehabilitation Services, Psychiatry Services, Hospital Pharmacy, Social Work and Palliative Care Services also support the new Hematogeriatric Oncology Programme.

Consultations in the Gharbi building

The Gharbi building, a general hospital in the Val d’Hebron, located in the Pere Virgili health park, provides consultations for patients with lymphoma and myeloma, as well as consultations for patients with lung cancer, colon and rectal cancer, prostate and urinary tract cancer. buffet, and oncogeriatric consultation for patients with breast cancer is carried out in the department of breast pathology of the women’s hospital. The Gharbi building, dedicated to the care of COVID-19 patients at the Val d’Hebron University Hospital during the pandemic, is now mainly dedicated to cancer patients: the second floor houses hospitalized cancer patients, while the third floor houses the Adult Oncology Hospital. Day.

Val d’Hebron is an international referral center for cancer, including medical oncology, radiation oncology, clinical hematology and various surgical services. A very important part of his work is focused on cancer in patients aged 70 years and older. It is also the only one in the state accredited by the Organization of European Cancer Institutes (OECI) as a Comprehensive Cancer Centre.