Clinical Scorecard: Assessing Treatment Burden: An Analysis of the Patient Burden Score in 758 Individuals Across Three Urological Clinical Scenarios

At a Glance

Key Highlights

• Treatment burden consists of expected burdens, unexpected downsides (complications), and need for ancillary procedures.
• Existing scales like the modified Clavien system assess only complication severity, omitting expected burdens and ancillary procedures.
• A novel Patient Burden Score was developed to integrate all three burden components to aid treatment decision-making.

Guideline-Based Recommendations

Diagnosis

• Use imaging studies to assess tumor recurrence and stone-free status post-treatment.
• Assess comorbidities using the Charlson Comorbidity Index.

Management

• Small renal masses: percutaneous ablation or laparoscopic robot-assisted partial nephrectomy based on patient-physician discretion.
• Muscle-invasive bladder cancer: neoadjuvant chemotherapy followed by radical cystectomy or trimodal therapy (maximal TUR followed by chemoradiation).
• Upper ureteral stones ≤ 10 mm: ureteroscopy or extracorporeal shockwave lithotripsy.

Monitoring & Follow-up

• Follow-up imaging at 3, 6, 12 months and annually for small renal masses.
• Monitor for complications and treatment success in all urological conditions with minimum six months follow-up.
• Stone-free status assessed one month after ureteral stone treatment.

Risks

• Consider risks of hospitalization, anesthesia, surgery, pain management, and potential mutilation.
• Monitor for postoperative complications such as bleeding, infection, and thromboembolic events.
• Account for the possibility of needing ancillary procedures if initial treatment fails.

Patient & Prescribing Data

758 patients treated for small renal masses, muscle-invasive bladder cancer, and upper ureteral stones at a tertiary center

Treatment modality selection was individualized; the Patient Burden Score provides a quantitative measure of treatment burden to complement success rates in decision-making.

Clinical Best Practices

• Incorporate comprehensive burden assessment including expected, unexpected, and ancillary procedure burdens when counseling patients.
• Use multidisciplinary input to assign weights reflecting patient treatment burden.
• Apply the Patient Burden Score alongside clinical outcomes to guide personalized treatment choices.

References

• Modified Clavien system for complication severity
• Common Terminology Criteria for Adverse Events v4.0
• Radiation Oncology Toxicity Grading (RTOG)
• Charlson Comorbidity Index