Groundbreaking Bladder Cancer Study Unveils Surprising Findings

An eye-opening interim analysis from the UW Bounceback Study has revealed that baseline physical function does not correlate with self-reported frailty in older patients undergoing radical cystectomy for bladder cancer. This groundbreaking finding was presented by a team led by Jordan Sheldon from the University of Washington at the recent 2025 American Urological Association (AUA) Annual Meeting in Las Vegas.

Decoding Frailty: A Unique Vulnerability Profile

The study analyzed 53 patients aged 65 and above, with a median age of 73. Notably, 72% of participants had an ECOG performance status of 0, meaning they had no functional limitations. Among them, 77% were male and 98% Caucasian. This diverse group had also undergone neoadjuvant chemotherapy prior to surgery.

Researchers utilized two prominent frailty assessments: the Short Physical Performance Battery (SPPB), which evaluates balance, gait speed, and lower extremity strength, and the Care and Aging Resilience Evaluation-Geriatric Assessment (CARE-GA), a self-reported tool generating a validated frailty index (CARE-FI). Patients underwent both assessments within four weeks leading up to their surgeries.

Unexpected Results: A Disconnect in Assessments

The results were striking. While only 4.3% of patients were classified as frail using the CARE-FI, none were deemed frail by the SPPB. The assessments showed no correlation with each other (K = .02; P = .9), emphasizing that they measure different aspects of vulnerability.

Interestingly, the analysis indicated a significant inverse relationship between CARE-FI scores and the length of hospital stay (K = -.4; P < .01), suggesting that higher frailty may lead to longer recovery. However, the SPPB scores did not influence length of stay (K = -.03; P = .8), and neither measure was connected to an increased risk of severe complications.

Towards Better Patient Outcomes: Future Directions

The authors highlighted that physical function is merely one element of the frailty puzzle. They also acknowledged the study's limitation due to its modest sample size.

The ongoing UW Bounceback Study aims to recruit more patients to further dissect the relationship between CARE-FI and SPPB scores, as well as their effects on recovery and oncologic outcomes post-surgery. Those eligible for enrollment are patients undergoing radical cystectomy, with or without neoadjuvant chemotherapy. This research hopes to unveil predictive markers for recovery trajectories and ultimately improve patient outcomes.