Bladder cancer in the elderly patient: challenges and solutions

Guancial, Elizabeth A.; Roussel, Breton; Bergsma, Derek; Bylund, Kevin; Sahasrabudhe, Deepak M.; Messing, Edward M.; Mohile, Supriya G.; Fung, Chunkit

doi:10.2147/cia.s74322

Cited by 39 publications

(30 citation statements)

References 95 publications

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“…Given that the median patient age at diagnosis of bladder cancer is 73 years and individuals aged 75–84 years account for the largest percentage of new cases (30%) 21 , an urgent need exists for clinical trials and interventions to improve outcomes in this population 94 . In addition to more-effective and less-toxic therapies, a coordinated multidisciplinary approach, geriatric assessment tools, and the incorporation of a geriatric oncologist can help identify patients with MIBC who are at an increased risk of chemotherapy-induced toxicity 95–97 .…”

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80–90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune-checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.

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Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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“…RadC is a complex surgical procedure, associated with complications, morbidity and extended hospital stays, even in experienced hands [ 28 29 ]. Patients ≥75 years often have longer hospital stays (5 days vs. 4 days, p=0.03) and higher minor complication rate (72% vs. 51%, p=0.04) than younger patients [ 30 ].…”

Section: Elderly Population Undergoing Bladder Cancer Treatments (Radmentioning

confidence: 99%

“…As mentioned previously, patients with MIBC can undergo a variety and combinations of treatments. Curative treatments for patients with MIBC have been reported to be either RadC or trimodal therapy [ 29 ]. Poor surgical candidates or those who want to avoid a major surgery can choose to undergo a combined modality treatment, with RadC saved for treatment failure.…”

Section: Other Treatments For Elderly Bladder Cancer Patientsmentioning

confidence: 99%

Treatment of bladder cancer in the elderly

Erlich

Zlotta

2016

Investig Clin Urol

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As the population ages and life expectancy increases in the human population, more individuals will be diagnosed with bladder cancer (BC). The definition of who is elderly is likely to change in the future from the commonly used cut-off of ≥75 years of age. Physiological rather than chronological age is key. BC care in the elderly is likely to become a very common problem in daily practice. Concerns have been raised that senior BC patients are not given treatments that could cure their disease. Clinicians lack quantitative and reliable estimates of competing mortality risks when considering treatments for BC. Majority of patients diagnosed with BC are elderly, making treatment decisions complex with their increasing number of comorbidities. A multidisciplinary approach to these patients may be a way to incorporate discussion from various disciplines regarding treatment options available. Here we review various treatment options for elderly patients with muscle invasive BC and nonmuscle invasive BC. We include differences in treatments from robotic versus open radical cystectomy, various urinary diversion techniques, chemotherapy, radiation therapy and combination treatments. In clinical practice, treatment decisions for elderly patients should be done on a case-by-case basis, tailored to each patient with their specific histories and comorbidities considered. Some healthy elderly patients may be better candidates for extensive curative treatments than their younger counterparts. This implies that these important, life-altering decisions cannot be solely based on age as many other factors can affect patient survival outcomes.

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“…(3) The median age at diagnosis is approximately 72 years. (4) Its incidence in patients younger than 40 years of age is reported to be as low as 0.8%.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Survival for Adolescents and Young Adults with Urothelial Bladder Cancer: Results from the California Cancer Registry

Lara¹,

Brunson

Keegan

et al. 2016

Journal of Urology

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Purpose Bladder cancer is a common malignancy often diagnosed in older adults. Previous studies have reported racial/ethnic disparities in bladder cancer survival outcomes, but have not focused on younger patients. We sought to identify whether factors influencing cause-specific survival in adolescents and young adults (ages 15-39) differed from older adults, and to define prognostic factors specifically in adolescents and young adults using the California Cancer Registry. Materials and Methods Patients diagnosed with bladder cancer between 1988 through 2012 were included. The primary outcome measure was cause specific survival. A multivariable Cox proportional hazards regression model was used to evaluate predictors of cause-specific survival in patients of all ages and in adolescents/young adults. Interactions of age and other variables between younger and older adult patients were assessed. Results Of 104,974 bladder cancer patients, we identified 1,688 adolescent and young adult patients (1.6%). When compared to older patients, these patients had a 58% reduced risk of bladder cancer death (Hazard Ratio 0.42; p<0.001). Significant age interactions were identified involving race/ethnicity and histology. Among AYAs, non-Hispanic African Americans with low socioeconomic status had poor cause- specific (Hazard Ratio 7.1, p<0.001) and overall (Hazard Ratio 5.02, p<0.001) survival. Conclusions Racial/ethnic and socioeconomic disparities exist in adolescent and young adult patients with bladder cancer in California. Further studies are warranted to identify the underlying causes in order to overcome these disparities.

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Bladder cancer in the elderly patient: challenges and solutions

Cited by 39 publications

References 95 publications

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Treatment of bladder cancer in the elderly

Determinants of Survival for Adolescents and Young Adults with Urothelial Bladder Cancer: Results from the California Cancer Registry

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