Adjuvant Chemo Use Lower in Oldest Bladder CA Patients

It offers a survival benefit regardless of age, but is used less often in older patients.
It offers a survival benefit regardless of age, but is used less often in older patients.

ORLANDO—Adjuvant chemotherapy (ACT) after radical cystectomy for muscle-invasive bladder cancer (MIBC) is associated with improved survival among elderly patients, but its use is significantly lower among older individuals, according to a new Canadian study presented at the American Urological Association 2014 annual meeting.

Michael Leverage, MD, and colleagues at Queen's University in Kingston, Ontario, studied 2,738 patients who underwent radical cystectomy for MIBC. Of these, 1,286 were younger than 70 years, 617 were aged 70-74 years, 497 were aged 75-79 years, and 338 were aged 80 years or older. Overall survival (OS) rates at 5 years in these age groups were 36%, 28%, 21%, and 21%, respectively.

Cancer-specific survival (CSS) rates at 5 years were 38%, 31%, 30%, and 30%, respectively. Rates of ACT use decreased significantly with age: 30%, 15%, 9%, and 3%. Compared with patients aged 70-74 years, patients aged 80 years or older were 84% less likely to receive ACT. In adjusted analyses, ACT was associated with improved OS and CSS.

Among patients younger than 70 years and 70 years and older, ACT was associated with a 30% and 36% decrease risk of death from any cause, respectively, and a 29% and 27% decreased risk of death from bladder cancer.

The study also showed that lymph node dissection was used significantly less frequently in older patients. The procedure was performed in 74% of patients younger than 70, 67% of those aged 70-74 and 75-79, and 57% of those aged 80 and older.

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