Assessments of frailty in bladder cancer.

Published

Journal Article (Review)

BACKGROUND AND AIMS: The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and decreased physiologic reserve, frail patients are vulnerable to stressors of disease and have poorer mortality and morbidity rates than their nonfrail peers. The association between frailty and poor outcomes has been documented across multiple populations, including radical cystectomy, creating a need for frailty assessments to be used preoperatively for risk stratification. We aim to provide a review of the common frailty assessments and their relevance to radical cystectomy patients. FINDINGS: A variety of assessments for frailty exist, from short screening items to comprehensive geriatric assessments. The syndrome spans multiple organ systems, as do the potential diagnostic instruments. Some instruments are less practical for use in clinical practice by urologists, such as the Canadian Study of Health and Aging Frailty Index and Comprehensive Geriatric Assessment. The tool most studied in radical cystectomy is the modified Frailty Index, associated with high grade complications and 30-days mortality. Frailty often coexists with malnutrition and sarcopenia, stressing the importance of screening for and addressing these syndromes to improve patient's perioperative outcomes. CONCLUSIONS: There is no universally agreed upon frailty assessment, but the most studied in radical cystectomy is the modified Frailty Index, providing valuable data with which to counsel patients preoperatively. Alterations in immune phenotypes provide potential future diagnostic biomarkers for frailty.

Full Text

Duke Authors

Cited Authors

  • Grimberg, DC; Shah, A; Molinger, J; Whittle, J; Gupta, RT; Wischmeyer, PE; McDonald, SR; Inman, BA

Published Date

  • September 2020

Published In

Volume / Issue

  • 38 / 9

Start / End Page

  • 698 - 705

PubMed ID

  • 32451229

Pubmed Central ID

  • 32451229

Electronic International Standard Serial Number (EISSN)

  • 1873-2496

Digital Object Identifier (DOI)

  • 10.1016/j.urolonc.2020.04.036

Language

  • eng

Conference Location

  • United States