Impairment and Longitudinal Recovery of Older Adults Treated with Radical Cystectomy for Muscle Invasive Bladder Cancer

Abstract

Purpose: Treatment for muscle invasive bladder cancer includes radical cystectomy, a major surgery that can be associated with significant toxicity. Limited data exist related to changes in patient global health status and recovery following radical cystectomy. We used geriatric assessment to longitudinally compare health related impairments in older and younger patients with muscle invasive bladder cancer who undergo radical cystectomy.

Materials and methods: Older and younger patients (70 or older and younger than 70 years) with muscle invasive bladder cancer undergoing radical cystectomy at an academic institution were enrolled between 2012 and 2019. Patients completed the geriatric assessment before radical cystectomy, and 1, 3 and 12 months after radical cystectomy. For each geriatric assessment measure the Wilcoxon rank sum test was used to compare score distribution between age groups at each time point. The Wilcoxon signed rank test was used to compare distributions between time points within each age group.

Results: A total of 80 patients (42 younger and 38 older) were enrolled. Before radical cystectomy 78% of patients were impaired on at least 1 geriatric assessment measure. Both age groups had worsening physical function and nutrition at 1 month after radical cystectomy, with older patients having a greater decline in function than younger patients. Both groups recovered to baseline at 3 months after radical cystectomy and maintained this status at 1 year.

Conclusions: High rates of impairments were found across age groups in the short term after radical cystectomy, followed by recovery to baseline.

Keywords: cystectomy; geriatric assessment; quality of life; urinary bladder neoplasms.

Figure 1.

Percentage of patients impaired on each domain across time points for (A) patients under 70 years old and (B) patients age 70 and older. There were no significant differences between age groups in percentage of patients impaired on each domain at each time point.

Figure 2.

Percentage of patients categorized as robust, pre-frail, or frail at each time point for younger and older patients. Distribution of frailty categorization was significantly different between age groups at 3 months (p = 0.03). * p < 0.05.