Physical function and frailty measures offer distinct insights in patients with bladder cancer

An interim analysis of the UW Bounceback Study showed that baseline physical function was not associated with self-reported frailty assessments in older patients with bladder cancer who are undergoing radical cystectomy.¹

Data did show a significant association between CARE-FI assessment scores and length of stay.

According to the authors, led by Jordan Sheldon of the University of Washington in Seattle, this finding suggests that “Functional assessments and self-reported multi-domain frailty assessments provide different information characterizing individual vulnerability profiles.”

The data were recently presented at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada.

In total, the interim analysis included 53 patients aged 65 and older who were planned for radical cystectomy. The median age at study analysis was 73 years, and the majority (72%) of patients had an ECOG performance status of 0. In addition, 77% of patients were male, and 98% were Caucasian. Among all patients, 11 had undergone neoadjuvant chemotherapy.

According to the authors, “We assessed participants with 2 commonly used frailty assessments: the Short Physical Performance and Battery Assessment (SPPB): a rapid physical function assessment that evaluates balance, gait speed, and lower extremity strength; and the Care and Aging Resilience Evaluation-Geriatric Assessment (CARE-GA): a self-reported form used to generate a validated frailty index (CARE-FI).”

Patients in the study completed both the SPPB and CARE-GA assessments within 4 weeks prior to surgery. The investigators also measured length of stay and Clavien 90-day surgical complications.

Overall, 4.3% of patients (2 of 46) were considered frail per the CARE-FI, while 0% were considered frail per the SPPB. The 2 assessments were not shown to be correlated with one another (K = .02; P = .9).

However, data did show a significant inverse association between CARE-FI assessment scores and length of stay (K = -.4; P < .01). SPPB scores were not shown to be associated with length of stay (K = -.03; P = .8).

Further, neither the CARE-FI assessment scores nor the SPPB assessment scores were found to be associated with an increased risk of Clavien 3 or higher complications (both, P > .05).

On these findings, the authors emphasized, “These results underscore the fact that physical function is but one component of frailty.”

However, they did acknowledge that an important limitation of the current study is its modest sample size.

The prospective, observational cohort UW Bounceback Study is currently enrolling patients to better evaluate associations between CARE-FI and SPPB scores and patient-reported and oncologic outcomes after radical cystectomy.

The goal, they explain, is to identify predictors of recovery trajectories and patient outcomes following surgery. Patients are eligible for enrollment if they are undergoing radical cystectomy with or without neoadjuvant chemotherapy.²

REFERENCES

1. Sheldon J, Holt S, Brewer E, et al. Functional vs. self-reported frailty measures and postoperative outcomes after radical cystectomy in older adults with bladder cancer. J Urol. 2025;213(5S):e1271. doi:10.1097/01.JU.0001110168.15704.a3.19

2. Fred Hutch/UWMC Bladder/Urothelial Cancer Trials. Fred Hutchinson Cancer Center. October 5, 2023. Accessed May 7, 2025. https://www.fredhutch.org/content/dam/www/diseases/bladder-cancer/fred-hutch-bladder-urothelial-cancer-trials.pdf