PD47-12: The Care Assessment Need (CAN) score to estimate Life Expectancy in patients diagnosed with Bladder Cancer in the Veterans Health Administration

Sunday, September 12, 2021 8:00 PM to 10:00 PM


Authors: Bogdana Schmidt, Simon John Christoph Soerensen, I-Chun Thomas, Alan Thong, Brian Dietrich, Joseph Liao, Thomas F. Osborne, John T. Leppert

Introduction: Patients with muscle invasive bladder cancer are often older and present with comorbid conditions and tools that estimate life expectancy can guide clinical decision making for patients considering cystectomy. The Care Assessment Needs (CAN) score is an existing risk assessment tool that utilizes a variety of variables from electronic health records (EHR) and is automatically calculated for individual patients receiving care in the Veterans Health Administration (VHA). The CAN score produces a percentile score (0 to 99) that incorporates patient age, diagnoses, laboratory data, vital signs, medication use, and services utilization. We sought to investigate the utility of the CAN score to estimate 5-year life expectancy in patients with bladder cancer undergoing radical cystectomy.

Methods: We identified all patients diagnosed with bladder cancer who underwent radical cystectomy between 2013 and 2018 in the VHA. We utilized the CAN 1-year mortality model version 2.5, with score recorded within one month prior to surgery. We visualized unadjusted survival using Kaplan-Meier plots. We fit unadjusted and multivariable Cox proportional hazards models to determine the association between the CAN score and overall survival.

Results: We identified 1,192 patients with bladder cancer that were treated with radical cystectomy and had an available CAN score in the month prior to diagnosis. Median age at surgery was 68.2 (IQR 63.9, 72.6), 1,180 (99%) patients were male, 112 (9.4%) had neobladder urinary diversion, 680 (57%) had T2 or greater stage disease, 387 (32.5%) received neoadjuvant chemotherapy. Median Charlson comorbidity index (CCI) was 2.0 (IQR 0.0 ,4.0). Median CAN score was 60 (IQR 40, 75). In models adjusted for age, race, chemotherapy, and diversion type, the CAN score was independently associated with survival (HR per 5-unit change=1.08, 95%CI 1.06,1.10).

Conclusions: The CAN score is a readily available EHR score that is automatically calculated for individual patients receiving care in the VHA. The CAN score is strongly associated with survival following radical cystectomy for bladder cancer. Incorporating the CAN score into clinical practice can help clinicians efficiently risk-stratify patients to provide patient-centered bladder cancer care.

Source of Funding: None

Therapeutic Area
Oncology: Bladder/Urothelium/Urethra