Bladder Cancer Adjuvant Chemotherapy Underused in the Elderly

Patients aged 70 and older are less likely than younger patients to receive post-cystectomy treatment.
Patients aged 70 and older are less likely than younger patients to receive post-cystectomy treatment.

Adjuvant chemotherapy (ACT) after radical cystectomy for bladder cancer is associated with better cancer-specific and overall survival regardless of age, but older patients are less likely to receive it, a recent study found.

Michael J. Leverage, MD, of Kingston General Hospital in Kingston, Ontario, used the Ontario Cancer Registry to identify 3,320 patients who underwent radical cystectomy from 1994 to 2008. The researchers stratified patients by age: less than 70, 70–74, 75–79, and 80 years or older.

The proportion of patients who received ACT decreased significantly with age: 27%, 16%, 12%, and 5%, respectively, according to findings published online ahead of print in Urology. Compared with patients aged 70–74, those aged 75–79 and 80 years or older were 36% and 76% less likely to receive ACT.

For patients younger than 70 and 70 or older (elderly), ACT was associated with a significant 27% and 30% decreased risk of cancer-related and all-cause mortality, respectively.

Among patients who received ACT, 87% of patients younger than 70 received cisplatin compared with 73% of those aged 70 or older, a significant difference between groups.

The 90-day mortality rates were 5%, 8%, 9%, and 15% for patients aged less than 70, 70–74, 75–79, and 80 years or older, respectively. The age-stratified 5-year cancer-specific survival rates were 42%, 37%, 34%, and 32%, respectively. The 5-year overall survival rates were 40%, 34%, 28%, and 23%.

The finding that the elderly have improved overall and cancer-specific survival from ACT if they are fit enough to receive it “needs to be considered in light of the observational study design and the fact that residual confounding may explain some of the observed benefit of ACT,” the authors wrote. “However, on the basis of our results and the existing literature, we believe that ACT should not be withheld on the basis of age alone; this consideration may help to increase the use of ACT in select older patients.”

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