A PROSPECTIVE COHORT STUDY OF 112 ELDERLY PATIENTS WITH BLADDER CANCER: PREDICTIVE FACTORS OF EARLY DEATH AFTER A COMPREHENSIVE GERIATRIC ASSESSMENT
Sources of Funding: none
Introduction
Bladder Cancer (Bca) is significantly associated with aging. However, the correct management of BCa in the elderly remains controversial. The aim of the study is to analyse predictive factors of early death in a group of patients >70y, with Bca, at 100 days after a geriatric comprehensive assessment (CGA), in order to help in therapeutic decision making.
Methods
112 patients with Bca were enrolled. This is a multicentric and prospective cohort study approved by an ethics committee. A standardized comprehensive geriatric assessment (CGA) was done before the treatment decision and different geriatric data were collected: MMSE, MNA, BMI, Grip hand grip strength, ADL, IADL, GIRSg, Gait speed, QLQC30, Charlson, G8 and Balducci classification. Characteristics of cancer, social and demographic data were also collected. During a 100-days follow up, the rate of death, treatments made and geriatric interventions were collected.
Results
A total of 112 patients were enrolled, including 25,9 % of women and a mean age of 82y [70-96]. 26,8% (n=30) of patients died within the 100-days follow up. 34,8%(n=39) of patients had metastatic cancers. The most common proposed treatments, by the surgeron or the oncologist, were surgery (radical cystectomy) (44,6%) and chemotherapy (41,6%). In 35,7% of cases, CGA has modified the therapeutic decision, in favor to palliative care in 57,5%._x000D_ In univariate analyzes, metastatic cancers (HR= 2,7 [ 1,3-5,5],p=0,008), cognitive deficit (MMSE<24) (HR=3;2[1,5-7],p=0,003), confusion (HR=2,2 [1,1-4,5],p=0,032), under nutrition (MNA<17) (HR=6,9 [2,1-22],p<0,001), lower gait speed (HR=5,6 [2,4-12,9],p<0,001), social isolation (HR=4,5 [2,1-9,6], p<0,001), and loss of autonomy in ADL (HR=2,7 [1,1-6,2],p=0,023) and IADL (HR=2,7 [1,1-6,5],p=0,032) had significantly more risk of dying. The predictive factors of early death, in multivariate analyzes, were the metastatic cancers (HR=3,5 [1,6-7,5], p=0,002), the lower gait speed (HR=3,1 [1,2-7,7], p=0,015), social isolation (HR= 2,6 [1,2-5,9], p=0,02)and loss of autonomy in ADL (HR=3,3 [1,2-9,2],p=0,022)._x000D_ _x000D_
Conclusions
This study confirms that some geriatric data could be predictive of worse outcome. These results can help the geriatrician, the surgeon and the oncologist in decision making. But these data also encourage to propose targeted geriatric interventions to improve the patients’s prognosis, especially customize their perioperative care.
Funding
none
Marine SANCHEZ
Sébastien GONFRIER
Matthieu DURAND
Delphine BORCHIELLINI
Hervé QUINTENS
Romain PRADER
Rabia BOULAHSSASS
Olivier GUERIN