Clinical Report: Patient Burden Score in Urological Treatments Across 758 Cases

Overview

This study developed and applied a comprehensive Patient Burden Score (BS) to quantify treatment burden in 758 patients across three urological conditions: small renal masses, muscle-invasive bladder cancer, and upper ureteral stones. The BS integrates expected burdens, unexpected complications, and ancillary procedures, providing a novel tool to aid treatment decision-making beyond traditional success metrics.

Background

Treatment choice in urology often balances success rates with the burden imposed on patients. Traditional scales mainly assess complications but overlook expected treatment burdens and the need for additional procedures after initial treatment failure. This study addresses these gaps by creating a composite burden score encompassing all three burden types. The score was applied to patients treated for small renal masses, muscle-invasive bladder cancer, and upper ureteral stones, conditions with multiple accepted treatment options.

Data Highlights

The study included 758 patients treated between 2001 and 2022 at a tertiary center. Treatments analyzed were percutaneous ablation or partial nephrectomy for small renal masses; radical cystectomy or trimodal therapy for muscle-invasive bladder cancer; and ureteroscopy or shockwave lithotripsy for upper ureteral stones. The burden score weights were assigned by a multidisciplinary committee to reflect hospitalization, anesthesia, surgery, pain, organ loss, complications, follow-up, and ancillary procedures. Follow-up was at least six months unless death occurred earlier.

Key Findings

• The Patient Burden Score (BS) combines expected burdens, unexpected complications, and ancillary procedures, unlike existing scales that focus mainly on complications.
• For small renal masses, treatment options included percutaneous ablation and laparoscopic robot-assisted partial nephrectomy, with follow-up imaging at 3, 6, and 12 months.
• Muscle-invasive bladder cancer treatments compared were radical cystectomy with neoadjuvant chemotherapy versus trimodal therapy (maximal resection plus chemoradiation).
• Upper ureteral stones ≤10 mm were treated with ureteroscopy or extracorporeal shockwave lithotripsy, with stone-free status assessed one month post-procedure.
• The BS provides a quantitative measure to help patients, physicians, and healthcare managers compare treatment burdens alongside success rates.
• Disease recurrence was evaluated separately and not included in the burden score calculation.

Clinical Implications

The Patient Burden Score offers a practical, multidimensional assessment of treatment impact, enabling more informed shared decision-making in urology. Incorporating this score alongside success rates can better align treatment choices with patient preferences and expectations. This approach may improve patient satisfaction and optimize resource allocation in clinical practice.

Conclusion

The development and application of the Patient Burden Score represent a significant advancement in quantifying treatment burden in urology. This tool complements traditional success metrics and supports personalized treatment selection across common urological conditions.

References

1. Clavien et al. 2009 -- The Clavien-Dindo Classification of Surgical Complications
2. CTCAE v4.0 -- Common Terminology Criteria for Adverse Events
3. RTOG -- Radiation Therapy Oncology Group Toxicity Grading
4. Charlson et al. 1987 -- Charlson Comorbidity Index