Assessments of frailty in bladder cancer.

Grimberg, Dominic C

Shah, Ankeet

Molinger, Jeroen

Whittle, John

Gupta, Rajan T

Wischmeyer, Paul E

McDonald, Shelley R

Inman, Brant A

2020-06-01T21:19:19Z

2020-06-01T21:19:19Z

2020-05-22

2020-06-01T21:19:16Z

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.

S1078-1439(20)30195-2

1078-1439

1873-2496

https://hdl.handle.net/10161/20746

eng

Elsevier BV

Urologic oncology

10.1016/j.urolonc.2020.04.036

Bladder cancer

Diet

Frailty

Lifestyle

Physical activity

Assessments of frailty in bladder cancer.

Journal article

Grimberg, Dominic C|0000-0003-2289-4781

Shah, Ankeet|0000-0001-5073-3016

Whittle, John|0000-0002-3859-679X

Gupta, Rajan T|0000-0002-2984-5010

Wischmeyer, Paul E|0000-0002-3369-7911

Inman, Brant A|0000-0002-6060-4485

School of Medicine

Anesthesiology, General, Vascular, High Risk Transplant & Critical Care

Duke

Anesthesiology

Clinical Science Departments

Staff

Surgery

Duke Cancer Institute

Surgery, Urology

Institutes and Centers

Trauma, Acute, and Critical Care Surgery

Anesthesiology, Critical Care Medicine

Published