Prospectively collected functional vs. self-reported frailty measures and postoperative outcomes after radical cystectomy in older adults with bladder cancer.

INTRODUCTION AND

OBJECTIVES

The optimal tools to measure frailty in patients with bladder cancer are poorly defined. Our objective was to compare baseline physical function with self-reported frailty assessments, and to evaluate associations between functional vs. self-reported frailty assessments and postoperative outcomes.

METHODS

Adults ≥65 years old with bladder cancer anticipating radical cystectomy (RC) were preoperatively assessed with the Short Physical Performance and Battery Assessment (SPPB): a physical assessment evaluating balance, gait speed, and lower extremity strength; and the Care and Aging Resilience Evaluation-Geriatric Assessment: a self-reported form which generates a validated frailty index (CARE-FI). Associations between the two frailty measures, postoperative length of stay (LOS), and 90-day grade ≥3 Clavien Dindo complications were assessed.

RESULTS

About 53 participants were analyzed. Overall, 3/53 were frail per the CARE-FI, while 1/53 demonstrated poor performance per SPPB criteria. CARE-FI and SPPB frailty categories were strongly associated on an ordinal scale (Kendall's τ-b = 0.88, P = 0.02), agreement between categorical classifications was limited (weighted κ = 0.02). Patients classified as frail or pre-frail by CARE-FI were more likely to experience extended length of stay (≥7 days; P = 0.008, chi-square) and had a longer continuous LOS (P = 0.0013, Wilcoxon rank-sum) and were also more likely to experience a grade ≥3 complication (P = 0.04, chi-square). The SPPB was not significantly associated with either variable per chi squared analysis (P > 0.05 for both).

CONCLUSIONS

Functional and self-reported frailty assessments provide different information characterizing individual vulnerability profiles; however, only the CARE-FI was statistically associated with increased LOS and postoperative complications following RC.