Using patient-centered data and behavioral economics to improve physical conditioning, mobility, and healthcare utilization after radical cystectomy

Ryan Greysen, MD, MHS

University of Pennsylvania

Kenneth E. Covinsky, MD, MPH

University of California, San Francisco

Daniel Lee, MD, MS

University of Pennsylvania

Project Description:

The treatment for invasive bladder cancer, a radical cystectomy, is a complex surgery that affects an elderly at risk population, since the median age at diagnosis is 73 years. The recovery is often difficult, as 60% will experience a complication, 40% will be readmitted, and 7% may die within 90 days of the surgery. Mobility has been associated with postoperative outcomes, and has been shown to reduce healthcare utilization in elderly patients. However, this has not been tested in patients undergoing complex surgeries. Furthermore, we do not know how best to motivate patients to improve their mobility and maintain their functional status. Therefore, we are studying how behavioral economics principles and social incentives may influence mobility in patients undergoing radical cystectomy, and hopefully decrease health care utilization and complications.

Potential Impact:

There are several key findings that we are hoping to evaluate. First of all, this intervention has not been tested in patients undergoing complex surgeries. So uncovering how mobility affects postoperative complication risks is very important in this cohort. The majority of patients undergoing cystectomies are older men with primary caregivers. These tight social connections may help potentiate social incentives, and provide valuable evidence to identify facilitators and barriers to successful behavioral economics based interventions. Mobility interventions can be easily scalable, and so interventions tested out in this population could be easily applied to any elderly patient undergoing major surgery.

Next Steps:

Expansion of the trial to include other major abdominal surgeries would be key. Many other major abdominal surgeries such as colectomies and pancreaticoduodenectomies (Whipple) have very high complication rates, as high as those for cystectomies.

The importance/value of RCCN funding for this collaborative research:

Of utmost importance. The RCCN funding has provided enough funding for a research coordinator and some initial money for the supplies. Being connected to the RCCN and NIA has been valuable as a resource.