Geriatric assessment‐derived deficit accumulation and patient‐reported treatment burden in older adults with bladder cancer

Abstract

BackgroundWhen a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment‐derived Deficit Accumulation Index (DAI) and patient‐reported treatment burden in older adults with early‐stage, non‐muscle‐invasive bladder cancer (NMIBC).MethodsWe conducted a cross‐sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory‐6 (UDI‐6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open‐ended survey question (“What has been your Greatest Challenge in managing medical care for your bladder cancer”) and created a joint display with illustrative quotes by DAI category.ResultsAmong 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre‐frail, and 13.4% frail. In the multivariable model, DAI and UDI‐6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33–2.82). Individuals with UDI‐6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16–2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self‐management (18.2%), and appointment time (11.1%).ConclusionsDAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging‐related conditions with that resulting from cancer treatment.