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

• 批准号: 10704119
• 负责人: Sarah Patricia Psutka
• 金额: $ 14.36万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704119
• 关键词: Acute; Address; Adoption; Adverse event; Advocate; Aftercare; Age; Aging; Assessment tool; Body Composition; Cancer Patient; Caring; Clinical; Cognitive; Data; Decision Making; Development; Development Plans; Diagnosis; Dimensions; Elderly; Ensure; Evaluation; Event; 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; Treatment-related toxicity; Urogenital Cancer; Urologic Oncology; Work; adverse event risk; age-related muscle loss; aggressive therapy; 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 risk prediction; physically handicapped; prediction algorithm; predictive modeling; preference; preservation; prospective; risk stratification; sarcopenia; success; tool; treatment risk

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.

项目摘要/摘要： 老年癌症患者被不成比例地认为不适合积极的治疗，导致 癌症最终治愈率显著降低，结果也很差。我们缺乏可靠的预测工具 老年患者不良治疗相关事件的个性化风险和显著结果，如功能性 拒绝。虽然指南提倡广泛采用老年评估(GAS)来量化 老年癌症患者在治疗决策前的多维脆弱性，临床采用 低相关性与临床实践中缺乏评估GAS区分风险人群能力的数据有关 功能下降，不良的临床和肿瘤学结果。此外，传统天然气不包括 独立预测临床和肿瘤学结果的肌肉质量验证指标。膀胱癌是 评估和开发个性化的老年肿瘤风险分层工具的理想健康状况， 考虑到确诊时的中位年龄为73岁，合并症的高基线患病率， 与治疗相关的不良事件，以及如果不治疗，普遍的致命性。我们的目标是量化功能 新诊断的膀胱癌患者的下降，并开发结合GA- 基于虚弱和肌肉指标的功能衰退的结果、治疗相关的发病率和 死亡率。具体目标是：(1)描述老年人的患病率和功能衰退的预测因素 新诊断为膀胱癌的成年人，(1B)确定基线虚弱和肌肉指标是否可以预测 功能衰退，以及(2)评估脆弱程度、肌肉指标和治疗相关结果。 (即不良事件、存活率)在患有局部高危膀胱癌的老年人中。要实现目标1，基线 新诊断的老年膀胱患者的功能状态将与3个月的评估结果进行比较。 接受基于遗传算法的脆弱性自我评估和肌肉指标的癌症队列(N=250) 将开发预测模型。对于目标2，我们将构建与治疗相关的多变量模型 结合基于GA的脆弱性和肌肉指标的不良事件、术后并发症和死亡率 来自强大的膀胱癌登记。这项创新的研究通过将经过验证的 GA工具增加了健壮的身体成分数据。这项工作意义重大：这将是第一次研究 确定老年膀胱癌患者功能衰退的危险因素，同时解决紧急需求 验证严格的个人化风险分层工具，包括老年条件以告知治疗 决策，确保与患者的优先事项保持一致。这项工作将直接转化为成果的改进。 并推断为其他恶性肿瘤。这个GEMSSTAR项目，指导 委员会和专业发展计划将帮助PI成为为数不多的独立的 具有跨年龄、泌尿外科肿瘤学和以患者为中心的结果研究的专业知识的研究人员。

项目成果

Imaging Techniques to Determine Degree of Sarcopenia and Systemic Inflammation in Advanced Renal Cell Carcinoma.

• DOI: 10.1007/s11934-023-01157-6
• 发表时间: 2023-07
• 期刊: CURRENT UROLOGY REPORTS
• 影响因子: 2.6
• 作者: Schmeusser, Benjamin N.;Ali, Adil A.;Fintelmann, Florian J.;Garcia, Jose M.;Williams, Grant R.;Master, Viraj A.;Psutka, Sarah P.
• 通讯作者: Psutka, Sarah P.