Predicting Functional Decline and Clinical Outcomes in Newly Diagnosed Older Patients with Localized Bladder Cancer

预测新诊断的局限性膀胱癌老年患者的功能衰退和临床结果

• 批准号: 10704119
• 负责人: Sarah Patricia Psutka
• 金额: $ 14.36万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704119
• 关键词: Acute; Address; Adoption; Adverse event; Advocate; Aftercare; Age; Aging; Assessment tool; Body Composition; Cancer Patient; Caring; Clinical; Cognitive; Data; Decision Making; Development; Development Plans; Diagnosis; Dimensions; Elderly; Ensure; Evaluation; Event; Geriatric Assessment; Goals; Guidelines; Health; High Prevalence; Image; K-Series Research Career Programs; Knowledge; Life; Life Expectancy; Longevity; Malignant Neoplasms; Malignant neoplasm of urinary bladder; Measurement; Measures; Mentors; Methods; Modeling; Morbidity - disease rate; Muscle; Muscle function; Newly Diagnosed; Oncology; Operative Surgical Procedures; Outcome; Outcomes Research; Patient Preferences; Patient-Focused Outcomes; Patients; Postoperative Complications; Prevalence; Public Health; Quality of life; Recovery; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Self Assessment; Staging; Surgical Oncology; Surgical complication; Systemic Therapy; Toxic effect; Translating; Treatment-related toxicity; Urogenital Cancer; Urologic Oncology; Work; adverse event risk; age-related muscle loss; aggressive therapy; cancer care; cancer diagnosis; cancer therapy; chemotherapy; clinical practice; clinical predictors; clinical risk; cohort; comorbidity; demographics; experience; fitness; frailty; functional decline; functional independence; functional outcomes; functional status; high risk; human old age (65+); improved; individual patient; innovation; mortality; multidisciplinary; multiple chronic conditions; muscle form; neoplasm registry; novel; older patient; patient oriented; patient population; personalized risk prediction; physically handicapped; prediction algorithm; predictive modeling; preference; preservation; prospective; risk stratification; sarcopenia; success; tool; treatment risk

PROJECT SUMMARY/ABSTRACT: Older patients with cancer are disproportionately perceived as unfit for aggressive therapies, resulting in significantly lower rates of definitive cancer care and poor outcomes. We lack validated tools to reliably predict personalized risks of adverse treatment-related events and salient outcomes for older patients such as functional decline. While guidelines advocate for widespread adoption of Geriatric Assessments (GAs) to quantify multidimensional vulnerabilities prior to treatment decision-making in older patients with cancer, clinical adoption is low related to a dearth of data evaluating the ability of GAs in clinical practice to discriminate those at risk for functional decline, adverse clinical and oncologic outcomes. Furthermore, traditional GAs do not include validated metrics of muscle mass that independently predict clinical and oncologic outcomes. Bladder cancer is an ideal health condition in which to evaluate and develop personalized geriatric oncology risk stratification tools, given median age at diagnosis of 73 years, a high baseline prevalence of comorbidities, substantial risk of treatment-associated adverse events, and universal lethality if untreated. Our objective is to quantify functional decline in patients with newly diagnosed bladder cancer, and to develop prediction models incorporating GA- based frailty and muscle metrics for the outcomes of functional decline, treatment-associated morbidity and mortality. The Specific Aims are: (1A) To characterize prevalence and predictors of functional decline in older adults with newly diagnosed bladder cancer, (1B) to determine if baseline frailty and muscle metrics predict functional decline, and (2) To evaluate associations frailty, muscle metrics, and treatment-associated outcomes (i.e., adverse events, survival) in older adults with localized high-risk bladder cancer. To achieve Aim 1, baseline functional status will be compared with a 3-month assessment in a prospective newly diagnosed older bladder cancer cohort (N=250) undergoing a pretreatment GA-based frailty self-assessment and muscle metrics and a predictive model will be developed. For Aim 2, we will construct multivariable models for treatment-associated adverse events, postoperative complications, and mortality incorporating GA-based frailty and muscle metrics from a robust bladder cancer registry. This innovative study advances risk stratification by incorporating validated GA tools augmented with robust body composition data. This work is significant: it will be the first study to characterize risk factors for functional decline in older bladder cancer patients, while addressing the acute need to validate rigorous personalized risk stratification tools incorporating geriatric conditions to inform treatment decisions, ensuring alignment with patient priorities. This work will directly translate to improvements in outcomes of older patients with cancer and extrapolate to other malignancies. This GEMSSTAR project, mentoring committee, and professional development plan will help the PI to become one of the few independent investigators with expertise intersecting aging, urologic oncology, and patient-centered outcomes research.

项目摘要/摘要： 老年癌症患者不成比例地认为不适合侵略性疗法，导致 明显的癌症护理率明显降低。我们缺乏可靠预测的验证工具 对老年患者（例如功能）的不良治疗事件的个性化风险和显着结果 衰退。虽然指南提倡广泛采用老年评估（GAS）以量化 老年癌症患者治疗决策之前的多维漏洞，临床采用 与缺乏数据评估临床实践中气体能力区分有风险的数据的能力相关的数据很低。 功能下降，不良临床和肿瘤结局。此外，传统气体不包括 经过验证的肌肉质量指标，可以独立预测临床和肿瘤学结果。膀胱癌是 一个理想的健康状况，在其中评估和开发个性化的老年肿瘤科学风险分层工具， 考虑到73岁诊断时年龄的中位年龄，合并症的基线患病率很高 与治疗相关的不良事件和普遍的致死性，如果未经治疗。我们的目标是量化功能 新诊断的膀胱癌患者的下降，并开发纳入GA-的预测模型 基于功能下降的结果，与治疗相关的发病率和肌肉指标 死亡。具体目的是：（1a）表征较老的功能下降的患病率和预测指标 新诊断为膀胱癌的成年人（1B）确定基线脆弱和肌肉指标是否预测 功能下降，以及（2）评估关联脆弱，肌肉指标和与治疗相关的结果 （即不良事件，生存）在患有局部高危膀胱癌的老年人中。为了达到目标1，基线 将功能状态与预期的新诊断的较老膀胱中的3个月评估进行比较 癌症队列（n = 250）接受了预处理GA的脆弱自我评估和肌肉指标以及A 预测模型将开发。对于AIM 2，我们将构建用于治疗相关的多变量模型 不良事件，术后并发症以及纳入基于GA的脆弱和肌肉指标的死亡率 来自强大的膀胱癌注册表。这项创新的研究通过纳入经过验证的风险分层推动了风险分层 GA工具增强了强大的身体组成数据。这项工作很重要：这将是首次研究 表征了老年膀胱癌患者功能下降的危险因素，同时解决了急性需求 验证严格的个性化风险分层工具，结合了老年病情以告知治疗 决定，确保与患者的优先级保持一致。这项工作将直接转化为结果的改善 老年患者患有癌症，并推断出其他恶性肿瘤。这个Gemsstar项目，指导 委员会和专业发展计划将帮助PI成为少数独立的人物之一 具有专业知识的研究人员与衰老，泌尿科肿瘤学和以患者为中心的结果研究相交。

项目成果

Imaging Techniques to Determine Degree of Sarcopenia and Systemic Inflammation in Advanced Renal Cell Carcinoma.

• DOI: 10.1007/s11934-023-01157-6
• 发表时间: 2023-07
• 期刊: CURRENT UROLOGY REPORTS
• 影响因子: 2.6
• 作者: Schmeusser, Benjamin N.;Ali, Adil A.;Fintelmann, Florian J.;Garcia, Jose M.;Williams, Grant R.;Master, Viraj A.;Psutka, Sarah P.
• 通讯作者: Psutka, Sarah P.