Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Biostatistics Core, Geisinger, Danville, Pennsylvania, USA.
J Am Geriatr Soc. 2024 Feb;72(2):490-502. doi: 10.1111/jgs.18676. Epub 2023 Nov 16.
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).
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.
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%).
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.
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。
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。
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%）。
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。
