老年评估衍生的缺陷积累和老年膀胱癌患者的报告治疗负担。
Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer.
机构信息
Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Biostatistics Core, Geisinger, Danville, Pennsylvania, USA.
出版信息
J Am Geriatr Soc. 2024 Feb;72(2):490-502. doi: 10.1111/jgs.18676. Epub 2023 Nov 16.
BACKGROUND
When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC).
METHODS
We conducted a cross-sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory-6 (UDI-6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open-ended survey question ("What has been your Greatest Challenge in managing medical care for your bladder cancer") and created a joint display with illustrative quotes by DAI category.
RESULTS
Among 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre-frail, and 13.4% frail. In the multivariable model, DAI and UDI-6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33-2.82). Individuals with UDI-6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16-2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self-management (18.2%), and appointment time (11.1%).
CONCLUSIONS
DAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging-related conditions with that resulting from cancer treatment.
背景
当一个人的医疗工作量超过其资源时，他们就会面临治疗负担。在癌症和老龄化的交叉点上，对于老年早期非肌肉浸润性膀胱癌（NMIBC）患者的治疗负担知之甚少。我们评估了老年评估衍生的缺陷累积指数（DAI）与老年早期非肌肉浸润性膀胱癌（NMIBC）患者报告的治疗负担之间的关系。
方法
我们对老年 NMIBC 患者（≥65 岁）进行了横断面调查。我们使用癌症和老龄化研究组的老年评估计算了 DAI，并使用尿生殖窘迫量表-6（UDI-6）测量了尿症状。主要结局是治疗负担问卷（TBQ）评分。我们使用具有 LASSO 惩罚的负二项式回归来对 TBQ 进行建模。我们还对一个开放问题（“在管理膀胱癌的医疗护理方面，您最大的挑战是什么？”）的回答进行了定性主题内容分析，并根据 DAI 类别创建了一个联合展示，其中包含说明性引述。
结果
在 119 名患者中，平均年龄为 78.9 岁（SD 7），其中 56.3%为健壮，30.3%为脆弱前期，13.4%为脆弱。在多变量模型中，DAI 和 UDI-6 与 TBQ 显著相关。DAI 高于中位数（>0.18）的个体的 TBQ 评分比 DAI 低于中位数的个体高 1.94 倍（调整后的 IRR 1.94，95%CI 1.33-2.82）。UDI-6 大于中位数（25）的个体的 TBQ 评分比 UDI-6 低于中位数的个体高 1.7 倍（调整后的 IRR 1.70，95%CI 1.16-2.49）。在“最大挑战”问题回答中的前 5 个主题是癌症治疗（22.2%）、癌症担忧（19.2%）、排尿困扰（18.2%）、自我管理（18.2%）和预约时间（11.1%）。
结论
DAI 和恶化的尿症状与老年 NMIBC 患者的更高治疗负担相关。这些数据强调需要采用整体方法，协调与衰老相关疾病相关的负担与癌症治疗相关的负担。
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