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Quantifying treatment burden: the patient burden score a study of 758 patients across three clinical urologic
Ofer N Gofrit1, S Nahum Goldberg2, Amitay Lorber2
1Departments of Urology, Radiology, and Oncology, Hadassah Hebrew University Hospital, P.O.Box 12000, Jerusalem, 91120, Israel. ogofrit@gmail.com.
Insights
A new Burden Score (BS) quantifies treatment impact, including complications and ancillary procedures. Less invasive options like percutaneous ablation for renal masses and ureteroscopy for stones offer similar success with lower BS.
Area of Science:
- Urology
- Medical Economics
- Health Services Research
Background:
- Treatment decisions in urology often involve balancing efficacy with patient burden.
- Quantifying the multifaceted burden of different treatment options is crucial for informed patient-provider discussions.
- Existing metrics may not fully capture the comprehensive impact of treatments, including expected and unexpected outcomes.
Purpose of the Study:
- To develop and validate a comprehensive Burden Score (BS) to measure the total burden of urological treatments.
- To compare the BS of different treatment modalities for specific urological conditions.
Main Methods:
- A panel of experts developed a scale assessing treatment aspects: hospitalization, anesthesia, surgery, and follow-up.
- The Burden Score (BS) was retrospectively calculated for patients undergoing treatments for renal masses, bladder cancer, and ureteral stones.
- Comparative analysis of BS was performed between treatment options within each clinical scenario.
Main Results:
- For small renal masses, partial nephrectomy (PN) had a BS more than twice that of percutaneous ablation (PA) (27.3 vs. 12.5).
- For muscle-invasive bladder cancer, trimodal therapy (TMT) had a significantly lower BS than radical cystectomy (RC) (42.0 vs. 53.8).
- For upper ureteral stones, ureteroscopy had a significantly lower BS than extracorporeal shock-wave lithotripsy (SWL) (7.8 vs. 9.0).
Conclusions:
- Percutaneous ablation, TMT, and ureteroscopy offer comparable success rates to PN, RC, and SWL, respectively, but with a significantly lower Burden Score.
- The developed BS provides a valuable tool for patient consultation when multiple treatment options exist.
- The Burden Score concept has potential applicability across various medical fields.
Objectives:
To develop a comprehensive scale that measures the three burden types of any treatment, including expected, unexpected (complications), and need for ancillary procedures.
Methods:
A panel of experts created a scale that assessed the burden of all aspects of treatment, including hospitalization, anesthesia, surgery, and follow-up. The total score is defined as the burden score (BS). BS was calculated retrospectively for patients in three clinical scenarios in urology, each with two acceptable treatment options: patients with a small renal mass (T1a) treated with either partial nephrectomy (PN, 139 patients) or percutaneous ablation (PA, 83 patients), patients with bladder cancer (stages T2-4a, N0, M0) treated with radical cystectomy (RC, 162 patients) or trimodal therapy (TMT, 88 patients), and patients with upper ureteral stones ≤ 10 mm treated with either ureteroscopy (137 patients) or extracorporeal shock-wave lithotripsy (SWL, 150 patients).
Results:
Both PN and PA provided excellent oncological results (5-year recurrence-free survival ≥ 97%) and low complication rates. However, the BS of PN was more than twice that of PA (27.3 ± 7.7 vs. 12.5 ± 6.4, p < 0.01). RC and TMT showed identical 3-year disease-specific survival rates (73%), but the BS of TMT was significantly lower (53.8 ± 11.1 vs. 42.0 ± 11.6, p < 0.01). Both ureteroscopy and SWL have achieved high stone-free rates (≥ 97%) and low complication rates. However, the BS of ureteroscopy was significantly lower (7.8 ± 3 vs. 9.0 ± 3.5, p < 0.01).
Conclusion:
PA treatment for small renal masses, TMT for muscle-invasive bladder cancer, and ureteroscopy for upper ureteral stones provided similar success rates to those of PN, RC, and SWL, but with significantly lower BS. This tool can assist in patient consultation when multiple treatment options are available. The concept of BS can be extended to other fields of medicine.
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