Quantifying treatment burden: the patient burden score a study of 758 patients across three clinical urologic scenarios

Abstract

Objectives To develop a comprehensive scale that measures the three burden types of any treatment, including expected, unexpected (complications), and need for ancillary procedures. Methods A panel of experts created a scale that assessed the burden of all aspects of treatment, including hospitalization, anesthesia, surgery, and follow-up. The total score is defined as the burden score (BS). BS was calculated retrospectively for patients in three clinical scenarios in urology, each with two acceptable treatment options: patients with a small renal mass (T1a) treated with either partial nephrectomy (PN, 139 patients) or percutaneous ablation (PA, 83 patients), patients with bladder cancer (stages T2-4a, N0, M0) treated with radical cystectomy (RC, 162 patients) or trimodal therapy (TMT, 88 patients), and patients with upper ureteral stones ≤ 10 mm treated with either ureteroscopy (137 patients) or extracorporeal shock-wave lithotripsy (SWL, 150 patients). Results Both PN and PA provided excellent oncological results (5-year recurrence-free survival ≥ 97%) and low complication rates. However, the BS of PN was more than twice that of PA (27.3 ± 7.7 vs. 12.5 ± 6.4, p < 0.01). RC and TMT showed identical 3-year disease-specific survival rates (73%), but the BS of TMT was significantly lower (53.8 ± 11.1 vs. 42.0 ± 11.6, p < 0.01). Both ureteroscopy and SWL have achieved high stone-free rates (≥ 97%) and low complication rates. However, the BS of ureteroscopy was significantly lower (7.8 ± 3 vs. 9.0 ± 3.5, p < 0.01). Conclusion PA treatment for small renal masses, TMT for muscle-invasive bladder cancer, and ureteroscopy for upper ureteral stones provided similar success rates to those of PN, RC, and SWL, but with significantly lower BS. This tool can assist in patient consultation when multiple treatment options are available. The concept of BS can be extended to other fields of medicine.