Most patients with bladder cancer have non muscle-invasive disease (NMIBC), requiring multiple invasive procedures during follow-up. Surveillance guidelines do not adjust for increasing age or frailty. We aim to evaluate the influence of frailty on the natural history of NMIBC.
Patients who died between 1/1/2017-1/1/2020 with bladder cancer and underwent a flexible cystoscopy within two years were identified via clinical coding. Notes were reviewed to establish relevant clinical parameters and follow-up procedures. Frailty was assessed using the 9-point Rockwood Clinical Frailty Scale (CFS): 1-3 no frailty, 4 vulnerable, 5-9 mild/severe frailty. The Charlson co-morbidity index and American Society of Anesthesiologists (ASA) score were similarly categorised.
69 patients were identified (mean age 78) with a median overall survival (OS) of 32.5 months. 36, 20 and 13 patients had frailty scores of 1-3, 4, and 5-9, respectively. There was no difference in the proportion of higher risk NMIBC between groups (table 1). Increasing frailty was associated with reduced OS (58.5, 28.5, 13 months; p <0.05) but not recurrence-free survival (24, 16, 27 months; p =0.98) or progress-free survival (144, n/a, n/a months; p =0.58) (figure 1). There was no clear difference in the number procedures per year of follow-up between groups (table 2). Progression or disease-specific mortality was the same across all groups (table 2). Similar results were obtained for the Charlson index and ASA scores. There were no frail patients with low or intermediate NMIBC who had a clinically significant progression prior to death from other causes (table 3).
There are frail patients with NMIBC who have limited life expectancy. For such patients with lower risk NMIBC, protocol-driven cystoscopic surveillance may not improve survival and watchful waiting may be more appropriate. Further investigation is required to determine the feasibility of this approach.

Analysing cause of death during follow-up for non-muscle invasive bladder cancer: Is there a role for watchful waiting?

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.