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Assessments of frailty in bladder cancer.

Publication ,  Journal Article
Grimberg, DC; Shah, A; Molinger, J; Whittle, J; Gupta, RT; Wischmeyer, PE; McDonald, SR; Inman, BA
Published in: Urol Oncol
September 2020

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.

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Published In

Urol Oncol

DOI

EISSN

1873-2496

Publication Date

September 2020

Volume

38

Issue

9

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Risk Assessment
  • Preoperative Period
  • Humans
  • Geriatric Assessment
  • Frailty
  • Aged
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences
 

Citation

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Chicago
ICMJE
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Grimberg, D. C., Shah, A., Molinger, J., Whittle, J., Gupta, R. T., Wischmeyer, P. E., … Inman, B. A. (2020). Assessments of frailty in bladder cancer. Urol Oncol, 38(9), 698–705. https://doi.org/10.1016/j.urolonc.2020.04.036
Grimberg, Dominic C., Ankeet Shah, Jeroen Molinger, John Whittle, Rajan T. Gupta, Paul E. Wischmeyer, Shelley R. McDonald, and Brant A. Inman. “Assessments of frailty in bladder cancer.Urol Oncol 38, no. 9 (September 2020): 698–705. https://doi.org/10.1016/j.urolonc.2020.04.036.
Grimberg DC, Shah A, Molinger J, Whittle J, Gupta RT, Wischmeyer PE, et al. Assessments of frailty in bladder cancer. Urol Oncol. 2020 Sep;38(9):698–705.
Grimberg, Dominic C., et al. “Assessments of frailty in bladder cancer.Urol Oncol, vol. 38, no. 9, Sept. 2020, pp. 698–705. Pubmed, doi:10.1016/j.urolonc.2020.04.036.
Grimberg DC, Shah A, Molinger J, Whittle J, Gupta RT, Wischmeyer PE, McDonald SR, Inman BA. Assessments of frailty in bladder cancer. Urol Oncol. 2020 Sep;38(9):698–705.
Journal cover image

Published In

Urol Oncol

DOI

EISSN

1873-2496

Publication Date

September 2020

Volume

38

Issue

9

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Risk Assessment
  • Preoperative Period
  • Humans
  • Geriatric Assessment
  • Frailty
  • Aged
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences