The Feasibility of a Health Care Application in the Treatment of Patients Undergoing Radical Cystectomy.

PURPOSE: Patients who undergo radical cystectomy of bladder cancer are at high risk for complications and hospital readmissions. Studies indicate insufficient preoperative education and perioperative monitoring. The aim of this study was to demonstrate the feasibility of implementing a health care application to provide more patient education and more thorough monitoring perioperatively. MATERIALS AND METHODS: Participants with home Wi-Fi access who were undergoing radical cystectomy were recruited for this pilot trial. Each subject was provided a tablet preloaded with the m.Care (LifeScience Technologies, Leawood, Kansas) health care application, an accelerometer and vital sign equipment. Participants were asked to watch educational videos, use the provided accelerometer and perform vital sign monitoring. RESULTS: In 1 year 20 participants enrolled in the study and 15 completed it. The most frequently viewed videos were "Ileal Conduit versus Neobladder" and "Comprehensive Care Pathway." All participants used the accelerometer and 60% kept up with syncing the data regularly. The average step count preoperatively was 5,679 reflecting a sedentary population. Step counts decreased during the inpatient stay (1,351 steps) and trended toward baseline during the postoperative period (3,156 steps). Vital signs were recorded on 85% of assigned days and generated 33 triggers for intervention. While most triggers led to repeat assessment, education and encouragement, 4 participants underwent outpatient treatment, including cultures, intravenous fluids, antibiotics or dronabinol prescription, without the need for hospital readmission. CONCLUSIONS: Providing more education and monitoring perioperatively is feasible using a health care application. Testing is warranted to determine the extent to which implementation will improve patient triaging and reduce readmissions.

Evaluating Financial Toxicity in Urologic Practice.

OBJECTIVE: To evaluate financial toxicity in Urologic surgery using the Comprehensive Score for financial Toxicity (COST) as well as validate a single item measure of toxicity. METHODS: A cross-sectional study of 182 patients undergoing oncologic and benign urologic procedures at a single academic medical center. Oncologic procedures included robotic assisted laparoscopic prostatectomy, transurethral resection of bladder tumor, and radical cystectomy. Benign procedures included holmium laser enucleation of the prostate, intravesical chemodenervation, ureteroscopy laser lithotripsy, and ureteral stent exchange. Retrospective review, patient interviews, and the previously validated COST survey, as well as a novel single item measure of toxicity were used pre and post-op. Descriptive statistics and logistic regression models compared COST scores by type of urologic procedure. RESULTS: Eighty (44%) patients underwent oncologic procedures and 102 (56%) benign procedures. Benign patients were most likely to have lower income and be younger than oncologic patients, with a median age of 56.7 vs 64.9. One in 4 patients undergoing urologic procedures experienced moderate to severe financial toxicity, without a statistically significant difference between the benign and the oncology groups pre- or post-operatively. Single item measure strongly correlated with COST (r = -0.80) pre- and post-operative. CONCLUSION: The COST survey and a single-item financial toxicity measure are both valid tools that can be used to measure financial toxicity in urology. Further research is needed to elicit the exact cause of financial toxicity in the heterogenous urologic patient population.