Presentation Authors: Gregory Chesnut*, Amy Tin, Daniel Sjoberg, Saman Sarraf, New York, NY, Brian Jang, New Orleans, LA, Harry Herr, Machele Donat, Guido Dalbagni, Bernard Bochner, Armin Shahrokni, Alvin Goh, New York, NY
Introduction: Decreased fitness (&[Prime]frailty&[Prime]) of older cancer patients is associated with postoperative adverse outcomes following radical cystectomy (RC). Prospective tools to identify factors impacting outcomes in this population are needed. We describe a novel electronic rapid fitness assessment (eRFA) as a preoperative geriatric assessment tool to evaluate patients undergoing RC.
Methods: Prior to undergoing radical cystectomy (RC) from February 2015-February 2018, patients over the age of 75 completed the eRFA by answering questions online and had perioperative comanagement by the Geriatrics Service. The eRFA evaluated physical and cognitive function over 12 domains, including Timed Up and Go (TUG) and Mini-Cog. An accumulated geriatric deficit (AGD) score is the composite of the number of impairments (0-12). Rate of intensive care unit (ICU) admission, urgent cancer center visits (UCC), readmission, and major complications within 30 days postoperatively were identified and reported based on deficits in any of the 12 domains or composite AGD assessed using eRFA.
Results: Of 81 patients who completed the eRFA, 68 underwent RC without concomitant procedures and were included for analysis. Median age was 80 (77, 84) and 54 (79%) were male. ICU admission, UCC visits, readmissions, and major complications were observed in 8.8%, 13.2%, 7.4%, and 11.8% of patients, respectively, within 30 days. Impairment identified by eRFA was seen in higher proportions of patients admitted to the ICU, with UCC visits, and in those who experienced a major complication (Table). A greater proportion of patients had ICU admission, UCC visit, and major complications in patients with abnormal TUG. Rates of readmission were similar between patients with or without deficits on the 12 eRFA domains. AGD significantly correlated with ICU admission (p=0.035) but not with UCC visit, readmission, or major complications.
Conclusions: We demonstrate feasibility of assessing fitness in patients over 75 undergoing RC using a novel fitness tool, the eRFA. In this small cohort, physical limitations and overall impairment correlated to ICU admission and adverse postoperative outcomes following RC. Larger studies are required to validate the relationship between eRFA and surgical outcomes after RC.
Source of Funding: National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grantto Memorial Sloan Kettering Cancer Center [P30 CA008748]