Geriatric Assessment-derived Deficit Accumulation and Patient-reported Treatment Burden in Older Adults with Bladder Cancer

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2023 Nov 17

PMID 37974546

Authors

Tullika Garg

Katie Frank

Alicia Johns

Kirstin Rabinowitz

John F Danella

H Lester Kirchner

Matthew E Nielsen

Carmit K McMullen

Terrence E Murphy

Harvey J Cohen

Affiliations

Soon will be listed here.

Abstract

Background: When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC).

Methods: We conducted a cross-sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory-6 (UDI-6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open-ended survey question ("What has been your Greatest Challenge in managing medical care for your bladder cancer") and created a joint display with illustrative quotes by DAI category.

Results: Among 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre-frail, and 13.4% frail. In the multivariable model, DAI and UDI-6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33-2.82). Individuals with UDI-6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16-2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self-management (18.2%), and appointment time (11.1%).

Conclusions: DAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging-related conditions with that resulting from cancer treatment.

Citing Articles

"Faith and a sunny day": Association of patient frailty with strain experienced by informal caregivers of older adults with non-muscle-invasive bladder cancer.

Garg T, Maheshwari C, Frank K, Johns A, Rabinowitz K, Danella J J Geriatr Oncol. 2024; 15(8):102060.

PMID: 39244892 PMC: 11560472. DOI: 10.1016/j.jgo.2024.102060.

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