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Treatment of muscle invasive bladder cancer in the elderly: navigating the trade-offs of risk and benefit

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A Letter to the Editor to this article was published on 24 March 2016

Abstract

Purpose

Despite the fact that bladder cancer patients have the highest median age of any type of cancer, older patients with muscle invasion are often under-treated.

Methods

In this review, we report the most up to date literature on the patterns of care and treatment of older patients with muscle invasive bladder cancer. Data on under-treatment, geriatric principles, cystectomy, perioperative chemotherapy, and bladder preservation for older patients are presented and analyzed.

Conclusion

Chronologic age should not exclude patients from curative-intent therapy. Functional age as determined by geriatric assessments and multidisciplinary evaluation can help clinicians decide on the best course of treatment for individual patients. Cystectomy, perioperative chemotherapy, and curative-intent bladder preservation are reasonable options in healthy older adults. Observation should be limited to patients with extremely poor performance status and very limited life expectancy.

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Acknowledgments

The authors would like to acknowledge the support of Gary Steinberg, Diane Quayle, and the staff and volunteers of the Bladder Cancer Advocacy Network.

Author contributions

VanderWalde involved in project development, manuscript writing/editing, Chi involved in manuscript writing/editing, Hurria involved in manuscript writing/editing, Galsky involved in manuscript writing/editing, and Nielsen involved in project development, manuscript writing/editing.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Tennessee Health Science Center, 1265 Union Ave. Thomas Basement, Memphis, TN, 38104, USA

    Noam A. VanderWalde

  2. University of Tennessee West Cancer Center, 100 N. Humphrey’s Blvd., Memphis, TN, 38120, USA

    Noam A. VanderWalde & Michelle T. Chi

  3. Cancer and Aging Program, Division of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte RD, Duarte, CA, 91010, USA

    Arti Hurria

  4. Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, 3rd Floor, New York, NY, 10029, USA

    Matthew D. Galsky

  5. Division of Urologic Oncology, Department of Urology, University of North Carolina at Chapel Hill, 2105 Physicians Office Building, Chapel Hill, NC, 27599, USA

    Matthew E. Nielsen

Authors
  1. Noam A. VanderWalde
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  2. Michelle T. Chi
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  3. Arti Hurria
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  4. Matthew D. Galsky
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  5. Matthew E. Nielsen
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Corresponding author

Correspondence to Noam A. VanderWalde.

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Conflict of interest

Dr. Hurria reports the following potential conflicts of interest: Principle Investigator on studies involving agents from Celgene and Glaxo-Smith-Kline. She also reports performing consultant services for GTx, Inc., Boehringer Ingelheim Pharmaceuticals, and On Q Health. Dr. Galsky reports the following potential conflicts of interest: Advisory Board Member for Merck and Novartis. He has received research funding from Celgene, Novartis, and BMS. Dr. Nielsen reports the following potential conflicts of interest: Research funding from the American Cancer Society and The Urology Care Foundation/Astellas. He has a consultant/advisory role for Grand Rounds. All other authors report no conflicts of interest.

Ethical standards

Dr. VanderWalde has received research funding from the Conquer Cancer Foundation of ASCO (Young Investigator Award 2014).

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VanderWalde, N.A., Chi, M.T., Hurria, A. et al. Treatment of muscle invasive bladder cancer in the elderly: navigating the trade-offs of risk and benefit. World J Urol 34, 3–11 (2016). https://doi.org/10.1007/s00345-015-1708-z

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  • DOI: https://doi.org/10.1007/s00345-015-1708-z

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