Impairment and Longitudinal Recovery of Older Adults Treated with Radical Cystectomy for Muscle Invasive Bladder Cancer

Osterman, Chelsea K.; Deal, Allison M.; McCloskey, Hannah; Nyrop, Kirsten A.; Bjurlin, Marc A.; Tan, Hung‐Jui; Nielsen, Matthew E.; Milowsky, Matthew I.; Muss, Hyman B.; Smith, Angela

doi:10.1097/ju.0000000000001323

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…5 Lawrence et al 5 concluded that the risk of disability even at 6 months after major surgery remained significant, and potentially modifiable factors, including preoperative physical status, depression, and postoperative complications, were associated with recovery. 5 A recent prospective study by Osterman et al 9 assessed recovery patterns of a number of domains after radical cystectomy, with a focus on patients older than 70 years. In both older and younger patients, the investigators observed worsening of TUGWT and iADL at 1 month after radical cystectomy with recovery by 3 months.…”

Section: Jama Network Open | Urologymentioning

confidence: 99%

“…Older patients were observed to have a greater worsening in physical function and QOL at 1 month. 9 McMullen et al 10 also reported that self-care was significantly affected after surgery, and transition to the home imposed a significant challenge. They used focus groups to elicit patient perspectives regarding preoperative decision making and complications of and recovery from radical cystectomy and provided a framework for assessing these domains.…”

Section: Jama Network Open | Urologymentioning

confidence: 99%

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Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

et al. 2022

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IMPORTANCENo data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). OBJECTIVE To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. INTERVENTIONS Robot-assisted radical cystectomy or open radical cystectomy (ORC). MAIN OUTCOMES AND MEASURES Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. FINDINGS Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI,] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI,] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than (continued) Key Points Question Is robot-assisted radical cystectomy (RARC) associated with faster recovery of patient-reported and performance-related measures of independence when compared with open radical cystectomy (ORC)? Findings This secondary analysis of the RAZOR (Randomized Open vs Robotic Cystectomy) trial found that patients require 3 to 6 months to recover baseline levels of independence irrespective of su...

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Section: Jama Network Open | Urologymentioning

confidence: 99%

Section: Jama Network Open | Urologymentioning

confidence: 99%

Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

et al. 2022

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“…Several studies have previously been performed to illustrate why BC is more likely to occur in men (2,(12)(13)(14)(15): one reason is the interaction of estrogen, androgens and the liver, and another reason is related to smoking, which increases the risk of BC because more men smoke than women (13,16). In addition, older patients are susceptible to BC due to degeneration of the body's immune system, leading to an increase in cancer incidence year by year (17)(18)(19). Additionally, the decline in bladder function and the development of benign prostatic hyperplasia in male patients as they aged leads to chronic urinary retention (20), which increases exposure to carcinogens and increases the risk of developing BC.…”

Section: Discussionmentioning

confidence: 99%

Incidence, prognostic factors and survival in bladder cancer patients: a population-based study

Shun-de¹,

Ge²,

Zhang³

2022

Transl Cancer Res TCR

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Background: The aim of this study was to investigate the incidence, epidemiologic characteristics, prognostic factors and survival of patients with bladder cancer.Methods: Bladder cancer patients diagnosed between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the independent prognostic factors for overall survival. Kaplan-Meier survival analysis and nomogram analysis were constructed based on the identified independent prognostic factors.Results: A total of 95,329 eligible bladder cancer patients were included in this study. Eight independent risk factors, including age, histologic type, race, tumor, node and metastasis (TNM) stage, American Joint Committee on Cancer (AJCC) stage, surgery, tumor metastasis and summary stage, were recognized by using multivariate logistic regression models. By comprising these factors, a predictive nomogram was constructed to predict the 1-, 3-, and 5-year overall survival possibilities. The concordance index and calibration curve showed that the nomogram had robust and accurate performance.Conclusions: Bladder cancer is the most common cancer of the urinary system, but the overall incidence has been decreasing yearly since 1992. Our results demonstrate eight factors significantly associated with overall survival in bladder cancer patients. Based on these factors, we established and validated a nomogram, which has the potential to provide an individualized prediction of overall survival in patients with bladder cancer.

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“…Osterman et al performed the only study to have included a GA before RC and at various times during 12 months of follow-up [ 22 ]. The researchers evaluated recovery in 80 patients aged 70 and over, in comparison to younger patients.…”

Section: Discussionmentioning

confidence: 99%

Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study

Geiss

Sebaste

Valter

et al. 2021

Cancers

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Radical cystectomy is the standard of care for localized bladder cancer but is associated with high morbidity and mortality rates—especially among older patients with comorbidities. The association between geriatric assessment parameters on post-operative complications and discharge has not previously been investigated. The present analysis of the Elderly Cancer Patient (ELCAPA) prospective cohort included all patients aged ≥70 having undergone a geriatric assessment and then radical cystectomy for localized muscle-invasive bladder cancer between 2007 and 2018. The primary endpoint was the proportion of patients with one or more complications in the first 30 days after cystectomy. The secondary endpoints were the length of hospital stay (LOS), the 30-day mortality, and discharge rates. Sixty-two patients (median age: 81; range: 79–83.8) were included. The 30-day complication rate was 73%, and 49% of the patients had experienced a major complication, according to the Clavien-Dindo classification. The 30-day mortality rate was 4%. None of the geriatric, oncological, or laboratory parameters were significantly associated with the occurrence or severity of complications. The median (interquartile range) LOS was 18 days (15–23) overall and was longer in patients with complications (19 days vs. 15 days in those without complications; p = 0.013). Thirty days after cystectomy, 25 patients (53%) had been discharged to home and 22 (47%) were still in a rehabilitation unit. In a univariate analysis, a Geriatric-8 score ≤ 14, a loss of one point on the Activities of Daily Living Scale, anemia, at least one grade ≥ 3 comorbidity on the Cumulative Illness Rating Scale-Geriatric, and an inpatient geriatric assessment were associated with a risk of not being discharged to home. In older patients having undergone a geriatric assessment, radical cystectomy is associated with a high complication rate, a longer LOS, and functional decline at 30 days.

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Impairment and Longitudinal Recovery of Older Adults Treated with Radical Cystectomy for Muscle Invasive Bladder Cancer

Cited by 9 publications

References 25 publications

Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

Incidence, prognostic factors and survival in bladder cancer patients: a population-based study

Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study

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