Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients

Abstract

Background:Bladder cancer (BC) predominantly affects the elderly and is often the cause of death among patients with muscle-invasive disease. Clinicians lack quantitative estimates of competing mortality risks when considering treatments for BC. Our aim was to determine the bladder cancer-specific mortality (CSM) rate and other-cause mortality (OCM) rate for patients with newly diagnosed BC.Methods:Patients (n=3281) identified from a population-based cancer registry diagnosed between 1994 and 2009. Median follow-up was 48.15 months (IQ range 18.1–98.7). Competing risk analysis was performed within patient groups and outcomes compared using Gray's test.Results:At 5 years after diagnosis, 1246 (40%) patients were dead: 617 (19%) from BC and 629 (19%) from other causes. The 5-year BC mortality rate varied between 1 and 59%, and OCM rate between 6 and 90%, depending primarily on the tumour type and patient age. Cancer-specific mortality was highest in the oldest patient groups. Few elderly patients received radical treatment for invasive cancer (52% vs 12% for patients <60 vs >80 years, respectively). Female patients with high-risk non-muscle-invasive BC had worse CSM than equivalent males (Gray's P<0.01).Conclusion:Bladder CSM is highest among the elderly. Female patients with high-risk tumours are more likely to die of their disease compared with male patients. Clinicians should consider offering more aggressive treatment interventions among older patients.

Radical Cystectomy and Adjuvant Chemotherapy for Bladder Cancer in the Elderly: A Population-based Study

“…[28][29][30] Published single-center series universally include patients who have undergone lymph node dissection in addition to RC; the higher long-term survival in these cohorts may reflect greater use of this surgical approach. 20,22,27 Elderly patients treated with RC were less likely than younger patients to receive ACT; only 5% of patients aged 80 years received ACT, as compared with 27% of those younger than 70 years. Those who did receive chemotherapy after the age of 70 years were less likely to receive cisplatin than younger patients.…”

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

“…These factors are practically impossible to elucidate from retrospective databases. The small amount of information available is conflicting; treatment for all bladder cancer as recorded in the SEER database stratified into intravesical, systemic therapy or cystectomy has shown no difference by gender [32] and an English study of high-risk NMIBC noted that men and women were equally likely to receive Bacillus Calmette-Guérin (BCG) [33]. However, comparison of treatment of superficial cancers in a Spanish study found female patients were almost 5 times more likely to receive intravesical therapies after transurethral resection (TUR) compared with their male counterparts despite there being a greater proportion of men with G3pT1 tumors than women [20] (the difference was not explained by men opting for immediate cystectomy), and 2 American studies have indicated that a higher proportion of female patients receive radiotherapy for MIBC [22,31].…”

Zoledronic acid inhibits the pentose phosphate pathway through attenuating the Ras-TAp73-G6PD axis in bladder cancer cells

“…Bladder cancer (BC) is a common malignancy of the urinary tract (1,2). Bone metastasis occurs in ~40% of patients with BC (3,4).…”