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Predicting Functional Decline and Clinical Outcomes in Newly Diagnosed Older Patients with Localized Bladder Cancer

预测新诊断的局限性膀胱癌老年患者的功能衰退和临床结果

基本信息

批准号：
10517212
负责人：
Sarah Patricia Psutka
金额：
$ 15.75万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10517212
关键词：
Acute Address Adoption Adverse event Advocate Aftercare Age Aging Assessment tool Body Composition Cancer Patient Caring Clinical Clinical Oncology Cognitive Data Decision Making Development Development Plans Diagnosis Elderly Ensure Evaluation Event Foundations Geriatric Assessment Goals Guidelines Health High Prevalence Image K-Series Research Career Programs Knowledge Life Life Expectancy Longevity Malignant Neoplasms Malignant neoplasm of urinary bladder Measurement Measures Mentors Methods Modeling Morbidity - disease rate Muscle Muscle function Newly Diagnosed Oncology Operative Surgical Procedures Outcome Outcomes Research Patient Preferences Patient-Focused Outcomes Patients Postoperative Complications Prevalence Public Health Quality of life Recovery Research Research Personnel Risk Risk Assessment Risk Factors Sampling Self Assessment Staging Surgical Oncology Surgical complication Systemic Therapy Toxic effect Translating Urogenital Cancer Urologic Oncology Work age-related muscle loss aggressive therapy base cancer care cancer diagnosis cancer therapy chemotherapy clinical practice clinical predictors clinical risk cohort comorbidity demographics experience fitness frailty functional decline functional independence functional outcomes functional status high risk human old age (65+)improved individual patient innovation mortality multidisciplinary multiple chronic conditions muscle form neoplasm registry novel older patient patient oriented patient population personalized predictions physically handicapped prediction algorithm predictive modeling preference preservation prospective risk stratification sarcopenia success tool treatment risk

项目摘要

PROJECT SUMMARY/ABSTRACT: Older patients with cancer are disproportionately perceived as unfit for aggressive therapies, resulting in significantly lower rates of definitive cancer care and poor outcomes. We lack validated tools to reliably predict personalized risks of adverse treatment-related events and salient outcomes for older patients such as functional decline. While guidelines advocate for widespread adoption of Geriatric Assessments (GAs) to quantify multidimensional vulnerabilities prior to treatment decision-making in older patients with cancer, clinical adoption is low related to a dearth of data evaluating the ability of GAs in clinical practice to discriminate those at risk for functional decline, adverse clinical and oncologic outcomes. Furthermore, traditional GAs do not include validated metrics of muscle mass that independently predict clinical and oncologic outcomes. Bladder cancer is an ideal health condition in which to evaluate and develop personalized geriatric oncology risk stratification tools, given median age at diagnosis of 73 years, a high baseline prevalence of comorbidities, substantial risk of treatment-associated adverse events, and universal lethality if untreated. Our objective is to quantify functional decline in patients with newly diagnosed bladder cancer, and to develop prediction models incorporating GA- based frailty and muscle metrics for the outcomes of functional decline, treatment-associated morbidity and mortality. The Specific Aims are: (1A) To characterize prevalence and predictors of functional decline in older adults with newly diagnosed bladder cancer, (1B) to determine if baseline frailty and muscle metrics predict functional decline, and (2) To evaluate associations frailty, muscle metrics, and treatment-associated outcomes (i.e., adverse events, survival) in older adults with localized high-risk bladder cancer. To achieve Aim 1, baseline functional status will be compared with a 3-month assessment in a prospective newly diagnosed older bladder cancer cohort (N=250) undergoing a pretreatment GA-based frailty self-assessment and muscle metrics and a predictive model will be developed. For Aim 2, we will construct multivariable models for treatment-associated adverse events, postoperative complications, and mortality incorporating GA-based frailty and muscle metrics from a robust bladder cancer registry. This innovative study advances risk stratification by incorporating validated GA tools augmented with robust body composition data. This work is significant: it will be the first study to characterize risk factors for functional decline in older bladder cancer patients, while addressing the acute need to validate rigorous personalized risk stratification tools incorporating geriatric conditions to inform treatment decisions, ensuring alignment with patient priorities. This work will directly translate to improvements in outcomes of older patients with cancer and extrapolate to other malignancies. This GEMSSTAR project, mentoring committee, and professional development plan will help the PI to become one of the few independent investigators with expertise intersecting aging, urologic oncology, and patient-centered outcomes research.

项目总结/文摘: