Association between treatment of superficial bladder cancer and 10‐year mortality in older adults with multiple chronic conditions

Abstract

Background Multiple chronic conditions (MCC) are common among older patients with cancer; however, the exclusion of these patients from clinical trials has resulted in scarce knowledge concerning outcomes, resulting in variations in treatment. Superficial bladder cancer (SBC) disproportionately affects older adults, yet to the authors’ knowledge few studies to date have examined whether treatment improves long‐term survival. In the current study, the authors evaluated the association between treatment of SBC and 10‐year mortality in medically complex older adults. Methods The authors identified 1800 older (aged ≥60 years) patients with SBC (American Joint Committee on Cancer stage ≤I) from 2 community‐based health systems who received treatment (bladder instillation and/or transurethral resection) or observation. Cox proportional hazards regression was performed adjusting for age, sex, race, health system, stage of disease/grade, and MCC (≥2 baseline chronic conditions). Propensity score analysis using stabilized inverse probability of treatment weights was used to compare 10‐year mortality in the 2 treatment groups with adjustment for covariates. Results Overall, 1485 patients (82.5%) and 315 patients (17.5%) received treatment and observation, respectively. In unweighted multivariable analysis, treatment was associated with a 30% reduction in death (adjusted hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.58‐0.85 [P<.01]) and MCC with a 72% increase in death (adjusted HR, 1.72; 95% CI, 1.44‐2.05 [P<.01]). Weighted analysis with adjustment (doubly robust) also demonstrated a survival benefit for treatment (adjusted HR, 0.66; 95% CI, 0.52‐0.84 [P<.01]). Conclusions The results of the current study demonstrated a clinically meaningful association between cancer treatment and survival benefit in older, medically complex patients with SBC, even after adjustment for medical complexity. These data provide a foundation for future work aimed at personalizing the treatment guidance of older patients with cancer with MCC.

Management of bladder cancer in older patients: Position paper of a SIOG Task Force

“…In summary, it is important to weigh the risks associated with TURBT and intravesical treatments against the benefits that these and follow-up procedures can provide in the context of an individual's life expectancy and quality of life. 30 Generally, TURBT and intravesical therapies are well tolerated in most older adult patients. However in frail older adults, intravesical therapies and TURBTs may lead to higher rates of urinary side effects and urinary tract infection 31 ; and repeated administration of general anaesthesia in older adults is associated with cognitive impairment.…”

Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

“…Both tools are available for ICD-9 codes but the ICD-10 codes remain in beta testing. We successfully used these tools with claims and electronic health record data [ 30 ].…”

Reply to Association between treatment of superficial bladder cancer and 10‐year mortality in older adults with multiple chronic conditions

“…We are grateful for the comments from Richard T. Bryan about our article. 1 Going forward, we will adopt the more precise non-muscle-invasive bladder cancer wording in future publications.…”