Background 

When doctors decide on bladder cancer treatments, they usually look at a patient’s overall health and age. But current tools don’t measure things like physical strength, memory, or mental health—all of which can affect how someone responds to treatment. A tool called the Comprehensive Geriatric Assessment (CGA) is designed to measure these factors, but it hasn’t yet been studied closely in bladder cancer patients. 

This project introduced a new tool called the Risk and Resilience (R2) assessment. It builds on the CGA by adding tests of body strength, body composition, and mental health. The goal is to get a clearer picture of a patient’s “physiological age”—how strong and resilient they truly are, beyond just their number of birthdays. 

What This Research Proposes to Address  

The researchers tested whether the R2 assessment helps improve patient care. They will measure its effect on things like anxiety, depression, quality of life, and how satisfied patients were with their cancer care. They also compared how the R2 tool worked against a doctor’s instinct or “gut feeling” about a patient’s health. 

Why This Research Is Important 

This study could give doctors and patients better information when making tough treatment decisions. By understanding a patient’s true strengths and vulnerabilities, doctors can give more personalized advice about the risks and benefits of each treatment. 

Most importantly, the R2 assessment can help patients feel more confident in their choices, reduce stress, and ensure they receive the treatment that fits their individual needs. This project aimed to make bladder cancer care more accurate, compassionate, and patient-centered. 

Final Report Summary

Doctors often rely on a patient’s age, other health problems, and overall strength to decide which bladder cancer treatments are safe. But these tools don’t always predict how well someone will do. That means doctors often depend on their own judgment, which can vary from person to person. 

To improve this, guidelines suggest using a tool called a Comprehensive Geriatric Assessment (CGA). A CGA looks more deeply at things like physical ability, memory, nutrition, and mental health. With support from BCAN, researchers tested a new version of this tool, called the Risk and Resilience Assessment, in a bladder cancer clinic. 

In one year, 94 patients joined the study, and most were able to complete the assessment. It measured frailty, mental health, resilience, and body composition. The results were given to both patients and doctors right away to help guide treatment conversations. 

The study found that patients and doctors sometimes disagreed about treatment choices, but those who used the assessment were more closely aligned. This shows the tool is practical and can give valuable insight. The next step is to study how the assessment relates to treatment results and quality of life, helping patients make better, more informed decisions. 

None Reported as of August 2025

None Reported as of August 2025

Ryan O’Malley, MD; University of Washington
Anne Browning, PhD; University of Washington
Florian Fintelmann, MD; Harvard University

Background 

People with muscle-invasive bladder cancer are usually treated with chemotherapy first, followed by surgery to remove the bladder, known as a radical cystectomy. While this treatment can be effective, it can also be very hard on patients—especially older adults or those with other health issues. These patients often experience complications and a lower quality of life during and after treatment. Because of this, doctors are looking for ways to help patients build up their strength before surgery so they can recover more easily. 

What the Study Proposes to Address 

This study will test a “prehabilitation” program—a plan that helps patients exercise and improve their physical fitness before and after surgery. A total of 128 bladder cancer patients who are receiving chemotherapy and preparing for bladder removal will take part. Half will follow a personalized exercise plan they can do at home, guided by a smartphone app called ExerciseRx. This app allows patients to safely complete their workouts while receiving real-time feedback and encouragement from their cancer care team. The other half will receive standard care without the exercise program. The study will measure how safe and practical this program is, and whether it helps patients improve strength, body composition, and quality of life, while also reducing complications during chemotherapy and recovery. 

Why This Research is Important 

This project could make bladder cancer treatment easier and safer for patients. By helping people get stronger before surgery, it may lower the risk of complications and help them recover faster. The program is also designed to be flexible, easy to use, and cost-effective, so more patients can benefit from it—no matter where they live or what their daily schedule looks like. Most importantly, this research directly answers patients’ requests for better ways to maintain their well-being and quality of life throughout their cancer journey. 

Hunter, H., Bennington-McKay, N., Sher, J., Psutka, S. P., & Lin, C. (2024). Emerging Role of Mobile Applications and Wearable Devices for Prehabilitation in Urologic Oncology. European urology focus, 10(1), 20–22. https://doi.org/10.1016/j.euf.2023.10.010

Petersen, E., Cavanaugh, D., & Psutka, S. P. (2024). Current developments in prehabilitation in urologic oncology. Current opinion in urology, 34(6), 477–483. https://doi.org/10.1097/MOU.0000000000001224

Petersen, E., Holt, S., Browning, A., Cavanaugh, D., Jannat, S., Wright, J., Gore, J., Schade, G., Reed, M., Garcia, J., Bentov, I., Master, V., Berry, D., Fintelmann, F. J., Marquardt, J. P., O’Malley, R., & Psutka, S. P. (2025). Characterizing Psychological Resources and Resilience in Patients With Bladder Cancer: Associations With Frailty and Quality of Life. The Journal of urology, 213(1), 40–51. https://doi.org/10.1097/JU.0000000000004257

Cavanaugh, D., Holt, S. K., Dwyer, E., Petersen, E., Gore, J. L., Schade, G. R., Grivas, P., Hsieh, A. C., Lee, J. K., Montgomery, B., Schweizer, M. T., Yezefski, T., Yu, E. Y., Chen, J. J., Liao, J. J., Weg, E., Zeng, J., Jannat, S., Berry, D. L., Master, V. A., … Psutka, S. P. (2025). Prospective evaluation of comprehensive geriatric assessments in multidisciplinary bladder cancer care and implications for personalized vulnerability phenotyping. Urologic oncology, 43(8), 468.e7–468.e18. https://doi.org/10.1016/j.urolonc.2025.03.025

Zhu, A., Sher, J., Li, R., Ioseliani, O., Cantor, L., Brewer, E. G., Landis, K., Bridges, D., Munson, S. A., Hunter, H., Lin, C., & Psutka, S. P. (2025). What motivates bladder cancer patients to be active? A qualitative study assessing attitudes towards physical activity and digital health technologies. Urologic oncology, 43(9), 522.e1–522.e8. 10.1016/j.urolonc.2025.05.002

Andy Hill Cancer Research Endowment (CARE) Implementation and Outcomes Research RFP, “EMPOWER TRIAL: A Phase II Randomized Controlled Clinical Trial evaluating a Scalable, Personalized Home-Based Activity Intervention with ExerciseRx in Survivors with Nonmuscle-Invasive Bladder Cancer”, 2024, $2,000,000

Cindy Lin, MD; University of Washington
Hanna Hunter (Oh), MD;University of Washington
Sean Munson, PhD ;University of Washington
Florian Fintelmann, MD; Harvard University