Real-world Impact of Integrating Comprehensive Geriatric Assessment into Clinical Treatment Decision-making for Older Patients with Bladder Cancer

Background and objective Treatment decision-making in older patients with bladder cancer (BC) is complicated by frailty and comorbidities. Comprehensive geriatric assessment (CGA) may support this process. This study evaluated the impact of CGA on treatment selection and identified CGA-prompted interventions in older patients with high-risk non–muscle-invasive BC (NMIBC) or muscle-invasive BC (MIBC). Design, setting, participants and intervention Patients aged ≥70 yr or aged <70 yr and deemed frail were referred for CGA after multidisciplinary team (MDT) discussion. Outcomes were discussed at a subsequent MDT meeting, and changes in treatment plans were recorded. The impact of CGA was defined as (1) modification of proposed treatment, (2) assessment of functional status because of concerns about resilience for treatment, or (3) guidance among multiple treatment options. Medical records were examined for CGA-prompted interventions. Overall survival (OS) was described according to CGA impact. Results and limitations Among 201 patients (79% male, median age 76 yr), CGA influenced treatment selection in 19% ( n = 38). In the impact group, CGA resulted in treatment de-escalation in 25 of the 38, assessed resilience in 7 of the 38, and guided selection among multiple options in 6 of the 38 patients. A total of 443 patient-specific interventions were generated, especially medication adjustments (22%), paramedical consultations (20%), and monitoring recommendations (18%). Compared with the no-impact group, patients in the impact group had poorer physical and cognitive performance and received best supportive care more frequently. Observed median OS was 8.4 versus 40.3 mo in MIBC and 19.4 versus not reached in NMIBC, likely reflecting underlying frailty and treatment selection. Conclusions CGA contributed to treatment selection in 1 in 5 patients, leading to de-escalation in frailer patients and supporting decisions when resilience or treatment choice was uncertain, demonstrating its potential to optimise treatment strategies.