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Geriatric conditions and treatment burden following diagnosis of non-muscle- invasive bladder cancer in older adults: A population-based analysis

  • Tullika Garg
    Correspondence
    Corresponding author at: Clinical Investigator Dept. of Urology Geisinger, 100 N. Academy Ave., Mail Code 01-27 Danville, PA 17822, United States of America.
    Affiliations
    Department of Urology, Geisinger, Danville, PA, United States of America

    Department of Population Health Sciences, Geisinger, Danville, PA, United States of America
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  • Alicia Johns
    Affiliations
    Department of Population Health Sciences, Geisinger, Danville, PA, United States of America

    Biostatistics Core, Geisinger, Danville, PA, United States of America
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  • Amanda J. Young
    Affiliations
    Department of Population Health Sciences, Geisinger, Danville, PA, United States of America

    Biostatistics Core, Geisinger, Danville, PA, United States of America
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  • Matthew E. Nielsen
    Affiliations
    Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America

    Departments of Epidemiology and Health Policy & Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, United States of America

    Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States of America
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  • Hung-Jui Tan
    Affiliations
    Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
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  • Carmit K. McMullen
    Affiliations
    Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States of America
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  • H. Lester Kirchner
    Affiliations
    Department of Population Health Sciences, Geisinger, Danville, PA, United States of America

    Biostatistics Core, Geisinger, Danville, PA, United States of America
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  • Harvey J. Cohen
    Affiliations
    Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States of America
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  • Terrence E. Murphy
    Affiliations
    Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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      Abstract

      Introduction

      Treatment burden is emerging as an important patient-centered outcome for older adults with cancer who concurrently manage geriatric conditions. Our objective was to evaluate the contribution of geriatric conditions to treatment burden in older adults with non-muscle invasive bladder cancer (NMIBC).

      Methods

      We identified 73,395 Medicare beneficiaries age 66+ diagnosed with NMIBC (Stage <II) in SEER-Medicare (2001–2014). The primary outcome was treatment burden, defined as health system contact days in the year following NMIBC diagnosis. Explanatory variables were the following geriatric conditions: multimorbidity (≥ 2 chronic conditions), functional dependency, falls, depression, cognitive impairment, weight loss, and urinary incontinence. We used negative binomial regression to model the association between individual geriatric conditions and treatment burden while adjusting for covariates.

      Results

      At baseline, 64% had multimorbidity and median 3 conditions (IQR 0–5). Prevalence of other geriatric conditions ranged from 5.9%–15.2%. Adjusted mean health system contact was 8.9 days (95% CI 8.6–9.2). Multimorbidity had the largest effect size (adjusted mean 11.8 contact days (95% CI 8.3–8.8)). Each additional chronic condition conferred a 13% increased average number of health system contact (adjusted IRR 1.132, 95% CI 1.129–1.135). Regardless of number of chronic conditions, rural patients consistently had more treatment burden than urban counterparts.

      Discussion

      In this population-based cohort of older NMIBC patients, multimorbidity and rurality were strongly associated with treatment burden in the year following NMIBC diagnosis. These findings highlight the need for interventions that reduce treatment burden due to geriatric conditions among the growing population of older adults with cancer, particularly in rural areas.

      Abbreviations:

      AJCC (American Joint Committee on Cancer), ASCO (American Society of Clinical Oncology), HCPCS (Healthcare Common Procedure Coding System), ICD (International Classification of Diseases), NMIBC (Non-Muscle-Invasive Bladder Cancer), SEER (Surveillance, Epidemiology, and End Results)

      Keywords

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