Impairment in Activities of Daily Living Assessed by the Barthel Index Predicts Adverse Oncological Outcomes after Radical Cystectomy for Bladder Cancer

The Barthel Index is a widely used tool to assess functional health status. This study tested its role in predicting disease recurrence and survival in patients diagnosed with bladder cancer treated with radical cystectomy. Our results demonstrated that a moderate, severe, or total functional impairment, indicated by a Barthel Index < 90, associated with worse prognosis, even after considering patient and tumor characteristics. Its use in daily clinical practice may improve the risk assessment of patients candidates to radical cystectomy. Introduction: We tested the association between functional impairment in activities of daily living (ADL) assessed through the Barthel Index (BI), and oncological outcomes following radical cystectomy (RC) for bladder cancer (BCa). Patients and Methods: We retrospectively analyzed data of 262 clinically nonmetastatic BCa patients, who underwent RC between 2015 and 2022, with available follow-up. According to preoperative BI, patients were divided in 2 groups: BI <90 (moderate/severe/total dependency in ADL) versus BI 95 to 100 (slight dependency/independency in ADL). Kaplan-Meier plots compared disease recurrence (DR)-, cancer-specific mortality (CSM)-, and overall mortality (OM)free survival according to established categor ies. Multivar iable Cox regression models tested the BI as an independent predictor of oncological outcomes. Results: According to the BI, the patient cohort was distributed as follows: 19% (n = 50) BI <90 versus 81% (n = 212) BI 95-100. Compared to patients with BI 95 to 100, patients with BI <90 were less likely to receive intravesical immuno- or chemotherapy (18% vs. 34%, p = .028), and more frequently underwent less complex urinary diversion as ureterocutaneostomy (36% vs. 9%, p < .001), or harbored muscle-invasive BCa at final pathology (72% vs. 56%, p = .043). In multivariable Cox regression models adjusted for age, ASA physical status score, pathological T and N stage, and surgical margins status, BI <90 independently predicted higher DR (HR [hazard ratio]:2.00, 95%CI [confidence interval]:1.21-3.30, p = .007), CSM (HR:2.70, 95%CI:1.48-4.90, p = .001), and OM (HR:2.09, 95%CI:1.28-3.43, p = .003). Conclusion: Preoperative impairment in ADL was associated with adverse oncological outcomes following RC for BCa. The integration of the BI into clinical practice may improve the risk assessment of BCa patients candidates to RC.