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Challenging treatment decision-making in older urologic cancer patients

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Cancer is the leading cause of death among patients aged 65 years and older. In this population, the cancer diagnosis is often made at a more advanced stage and worse prognosis than in younger patients. Specific mortality in older patients is superior to that reported in their younger counterparts. Moreover, the impact of curative treatment that has proven benefit in overall population may be not well studied in the sub-group of older patients. Thus, the management of cancer in the elderly is a major public health concern in most Western countries.

Methods/results

In this review, we summarize this challenging treatment decision-making in older urologic patients with prostate, kidney or bladder cancer. The estimation of life expectancy remains a difficult task. Chronological age should not be considered as the main decisive factor anymore when considering aggressive cancer treatment. Comorbidities increase the complexity of cancer management and affect survival. Multidisciplinary evaluation and comprehensive geriatrics assessment using specific scales are critical to improve the treatment decision-making and to minimize both overtreatment of low-risk disease and undertreatment of high-risk disease. When an aggressive and potential quality-of-life-threatening treatment is scheduled after this comprehensive geriatrics assessment, personalized patient care must be early predefined by the geriatric team.

Conclusions

In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs.

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Acknowledgments

The authors thank Astellas Pharma for their financial support.

Author information

Authors and Affiliations

  1. Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris 7 University, Paris, France

    Guillaume Ploussard & Pierre Mongiat-Artus

  2. Geriatric Evaluation and Management Unit, Lyon Civil Hospices, Antoine Charial Hospital, Francheville, France

    Gilles Albrand

  3. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    François Rozet

  4. Department of Urology, Strasbourg University Hospitals, Strasbourg, France

    Hervé Lang

  5. Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Elena Paillaud

  6. LIC EA 4393, Paris Est Créteil University (UPEC), Créteil, France

    Elena Paillaud

  7. U728, IHU-PRES Sorbonne Paris Cité, Paris, France

    Guillaume Ploussard & Pierre Mongiat-Artus

Authors
  1. Guillaume Ploussard
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  2. Gilles Albrand
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  3. François Rozet
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  4. Hervé Lang
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  5. Elena Paillaud
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  6. Pierre Mongiat-Artus
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Corresponding author

Correspondence to Guillaume Ploussard.

Additional information

Guillaume Ploussard, Gilles Albrand, Elena Paillaud and Pierre Mongiat-Artus have contributed equally to this work.

This article is a collaborative work from the Committee on Professional Practice of the French Urological Association and from the Uro-Gériatric Intergroup of the French Society of Geriatrics and Gerontology et the French Urological Association.

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Ploussard, G., Albrand, G., Rozet, F. et al. Challenging treatment decision-making in older urologic cancer patients. World J Urol 32, 299–308 (2014). https://doi.org/10.1007/s00345-013-1158-4

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  • DOI: https://doi.org/10.1007/s00345-013-1158-4

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