Aim: The aim of the study is to investigate the effect of a perioperative Comprehensive Geriatric Assessment (CGA), tailored interventions, and implementation of an interdisciplinary collaboration in older, frail patients with bladder cancer undergoing radical cystectomy.

Primary outcome is number of Days-Alive-Out-of-Hospital (DAOH) 90-days postoperatively. 

Number of patients included: 140 patients

Method: The study will be a national randomized trial. Patients ≥65 years of age and considered frail by assessment with the G8 screening tool, will be eligible for inclusion.

Patients will be randomized 1:1 and allocated into either control or intervention study arm. The control group will receive perioperative “care as usual” according to exciting principles and guidelines. The intervention will comprise a preoperative thorough geriatric multidisciplinary assessment focused on optimizing health issues of expected importance in further course of surgery. Furthermore, postoperative ward rounds by a geriatric team will be conducted. Thus, the course of treatment for each patient will be a close interdisciplinary collaboration. 

The geriatric assessment can be divided into several parts:

1. A thorough evaluatiom of the patients BEFORE the operation. The evaluation is based on conversation with the patient, journal entries, physical tests, and an examination performed by a doctor. Factors that influence the overall health and their upcoming operation will be explained to the patient through the use of standardised tests and questions. This will include list of medicines taken, other illnesses, level of physical function, mental health, cognition, nutrition, and social life. 

Should there be need for intervention then further examination or optimisation of treatment will be planned in coorporation with the patient and their relatives. The need for intervention can vary and will be diffrerent patient to patient. However, an example might be:

• Medicine: Stopping use of non-relevant medicine, pausing medicines that are thought to interfere with the upcoming operation or starting/adjusting the dosis of relevant medicine.
• Other illnesses: E.g. optimisation of diabetic treatment or iron treatment through blood loss etc.
• Physical competences: Physical function tested through a six minute walking test, stand-up-sit-down test, and strength of hand grip. Should it be relevant will the patient be offered a training session with a physiotherapist and a workout programme to do at home. 
• Nutrition: Investigation of eating problems, perhaps starting the patient up on supplementary vitamins and minerals.
• Mental health and cognition: Treatment of underlying depression, information about acute state of confusion and treatment.
• Social life: Information about the home situation and evaluation of a possible need for support or help after the operation.

2. Scheduled rounds in the bed section along the geriatric team AFTER the operation twice a week. 

Status: Including

Sites:  Dept. of Urology and Dept. of Geriatrics from:

• Aarhus University Hospital
• Odense University Hospital
• Aalborg University Hospital