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. 2024 Feb;72(2):490-502.
doi: 10.1111/jgs.18676. Epub 2023 Nov 16.

Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer

Tullika Garg  1 , Katie Frank  2   3 , Alicia Johns  2   3 , Kirstin Rabinowitz  4 , John F Danella  5 , H Lester Kirchner  3 , Matthew E Nielsen  6   7 , Carmit K McMullen  8 , Terrence E Murphy  9 , Harvey J Cohen  10
Affiliations

Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer

Tullika Garg et al. J Am Geriatr Soc. 2024 Feb.

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.

Keywords: bladder cancer; geriatric assessment; geriatric oncology; treatment burden; urinary symptoms.

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Conflict of interest statement

Matthew E. Nielsen serves as a paid consultant to the American College of Physicians High Value Care Task Force and to the American Urological Association. Dr. Nielsen serves as a consultant/advisor to Grand Rounds for which he is paid via stock options. Tullika Garg served as a paid consultant to WebMD in 2020, currently receives research funding from the Flume Catheter Company, LLC, and reports an immediate family member was an employee and a stockholder of DRPLZ through 2021. All other authors report no conflict of interest.

Figures

Figure 1:
Figure 1:
Distributions of a) Treatment Burden Questionnaire Scores (TBQ, Outcome), and b) Deficit Accumulation Index (DAI, Exposure)
Figure 2:
Figure 2:
Proportion of Treatment Burden Questionnaire (TBQ) Survey Items Reported as a Problem By Deficit Accumulation Index (DAI) Category
Figure 3:
Figure 3:
Adjusted Incidence Rate Ratios for the Deficit Accumulation Index (DAI) and the Urogenital Distress Inventory-6 (UDI-6) from the Negative Binomial Regression Model of the Treatment Burden Questionnaire Score
Figure 4:
Figure 4:
Joint Display of Most Common Greatest Challenge Themes by Deficit Accumulation Index (DAI) Category
See this image and copyright information in PMC

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