The standard of care for patients with muscle-invasive bladder cancer is radical cystectomy, the surgical removal of the bladder. However, this is a major operation, with a significant risk of complications and potentially, even death. "Radical cystectomy is not the ideal treatment for everyone, especially for higher-risk elderly patients with multiple medical problems," says Trinity Bivalacqua, M.D. Ph.D., Director of Urologic Oncology. Who would do well with this procedure, and who is a poor candidate? It's sometimes tough to predict. "Assessing surgical risk is a complicated task, and the surgeon must take several factors into account to determine how well someone will do in the operating room and in the immediate recovery period."

The key is frailty, he says. "We know that age alone does not tell us how a patient will do after surgery. Some patients are young but frail, while others are older with great physical reserve." Bivalacqua is the senior author of a study that can help identify patients who are more likely to have complications. This work was recently published in Urologic Oncology. In the study, Hopkins investigators led by medical student Meera Chappidi and urologist Max Kates, M.D., validated a modified frailty index or score.

"This is an objective measure that is calculated using a set of 11 questions that any patient can easily answer in a couple of minutes during an office visit," says Bivalacqua. "Patients with high frailty scores may have risk factors that can be optimized before surgery to decrease their chance of having a complication, or they may benefit from bladder-sparing therapies."