关键词: Bladder cancer CGA Frailty Health outcome priorities Treatment goals

Mesh : Humans Urinary Bladder Neoplasms / therapy Aged Male Female Quality of Life Aged, 80 and over Geriatric Assessment Patient Preference Frailty Health Priorities

来  源:   DOI:10.1016/j.jgo.2024.101811

Abstract:
BACKGROUND: Selecting the appropriate treatment for older patients with non-muscle invasive (NMIBC) or muscle-invasive bladder cancer (MIBC) is challenging due to smoking-related comorbidities, treatment toxicity, and an increased risk of adverse health outcomes. Considering patient preferences prior to treatment is therefore crucial. Here, we aimed to identify the health outcome priorities of older patients with high-risk NMIBC (HR-NMIBC) or MIBC.
METHODS: Patients aged 70 years or older or at risk for frailty, diagnosed with HR-NMIBC or MIBC without distant metastases, were referred for a comprehensive geriatric assessment (CGA). The CGA consisted of an interview, physical examination, and several tests to examine physical, cognitive, functional, and social status. Quality of life was assessed using EQ5D and EORTC QLQ-C30 questionnaires. Health outcome priorities were discussed using the Outcome Prioritization Tool (OPT) and associations between health outcome priorities and CGA-determinants and quality of life were studied.
RESULTS: Of 146 patients (14 HR-NMIBC, 132 MIBC), OPT data was available for 139. Life extension was most often prioritized (44%), closely followed by preserving independence (40%). Reducing pain (7%) and other symptoms (9%) were less often prioritized. Patients prioritizing life extension had fewer musculoskeletal problems than patients prioritizing reducing pain or other symptoms (p = 0.02). Patients at risk of or suffering from malnutrition more frequently selected reducing pain or other symptoms as their health outcome priority (p = 0.004). For all other CGA-determinants and quality of life, there were no significant differences between groups based on health outcome priorities.
CONCLUSIONS: In older patients with HR-NMIBC and MIBC, life extension and preserving independence are the most common health outcomes priorities. CGA-determinants and quality of life are generally not associated with the prioritization of health outcomes. As health outcome priorities cannot be predicted by CGA-determinants or quality of life, it is crucial to discuss health outcome priorities with patients to promote shared decision-making.
摘要:
背景:由于吸烟相关的合并症,为患有非肌肉浸润性膀胱癌(NMIBC)或肌肉浸润性膀胱癌(MIBC)的老年患者选择合适的治疗方法具有挑战性,治疗毒性,和不良健康结果的风险增加。因此,在治疗前考虑患者的偏好是至关重要的。这里,我们旨在确定高危NMIBC(HR-NMIBC)或MIBC老年患者的健康结局优先事项.
方法:年龄在70岁或以上或有虚弱风险的患者,诊断为HR-NMIBC或MIBC无远处转移,进行全面的老年评估(CGA)。CGA包括一次采访,体检,和一些检查身体的测试,认知,功能,和社会地位。使用EQ5D和EORTCQLQ-C30问卷评估生活质量。使用结果优先排序工具(OPT)讨论了健康结果优先事项,并研究了健康结果优先事项与CGA决定因素和生活质量之间的关联。
结果:146例患者(14例HR-NMIBC,132MIBC),OPT数据为139。延长寿命是最优先考虑的(44%),紧随其后的是保持独立性(40%)。减少疼痛(7%)和其他症状(9%)的优先级较低。与优先减轻疼痛或其他症状的患者相比,优先延长寿命的患者的肌肉骨骼问题更少(p=0.02)。有营养不良风险或患有营养不良的患者更频繁地选择减轻疼痛或其他症状作为他们的健康结果优先事项(p=0.004)。对于所有其他CGA决定因素和生活质量,根据健康结局的优先顺序,组间无显著差异.
结论:在HR-NMIBC和MIBC的老年患者中,延长生命和保持独立是最常见的健康结果优先事项.CGA决定因素和生活质量通常与健康结果的优先次序无关。由于CGA决定因素或生活质量无法预测健康结果的优先级,与患者讨论健康结局优先事项以促进共同决策至关重要.
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