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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要：老年癌症患者被不成比例地认为不适合积极治疗，导致明确的癌症治疗率和不良结果显着降低。我们缺乏经过验证的工具来可靠地预测老年患者的不良治疗相关事件和显着结果（例如功能）的个性化风险衰退。虽然指南提倡广泛采用老年评估 (GA) 来量化老年癌症患者治疗决策前的多维脆弱性、临床采用与缺乏数据评估 GA 在临床实践中区分有风险的人的能力相关性较低功能衰退、不良临床和肿瘤学结果。此外，传统的遗传算法不包括独立预测临床和肿瘤结果的经过验证的肌肉质量指标。膀胱癌是评估和开发个性化老年肿瘤风险分层工具的理想健康状况，鉴于诊断时的中位年龄为 73 岁，合并症的基线患病率较高，治疗相关的不良事件，以及如果不治疗则普遍致死。我们的目标是量化功能新诊断膀胱癌患者的死亡率下降，并开发结合 GA 的预测模型基于虚弱和肌肉指标来衡量功能下降、治疗相关发病率和死亡。具体目标是： (1A) 描述老年人功能衰退的患病率和预测因素新诊断出膀胱癌的成年人，(1B) 以确定基线虚弱和肌肉指标是否可以预测功能衰退，以及 (2) 评估虚弱、肌肉指标和治疗相关结果的关联（即不良事件、生存）患有局部高危膀胱癌的老年人。为了实现目标 1，基线将针对新诊断的老年膀胱的功能状态与 3 个月的评估进行比较癌症队列 (N=250) 接受基于 GA 的治疗前虚弱自我评估和肌肉指标以及将开发预测模型。对于目标 2，我们将构建与治疗相关的多变量模型结合基于 GA 的衰弱和肌肉指标的不良事件、术后并发症和死亡率来自强大的膀胱癌登记处。这项创新研究通过结合经过验证的方法来推进风险分层 GA 工具增强了可靠的身体成分数据。这项工作意义重大：这将是第一项研究描述老年膀胱癌患者功能衰退的危险因素，同时解决迫切的需求验证严格的个性化风险分层工具，结合老年疾病为治疗提供信息决策，确保与患者优先事项保持一致。这项工作将直接转化为成果的改善老年癌症患者的研究并推断其他恶性肿瘤。这个 GEMSSTAR 项目，指导委员会和专业发展计划将帮助PI成为少数独立的人之一具有衰老、泌尿肿瘤学和以患者为中心的结果研究领域专业知识的研究人员。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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

确定晚期肾细胞癌肌肉减少症和全身炎症程度的成像技术。

DOI：
发表时间：
2023-07
期刊：
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