Treating Bladder Cancer Ups Survival in Sicker Older Patients

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Older patients benefit from treatment of superficial bladder cancer even if they have multiple chronic conditions, a new study suggests.
Older patients benefit from treatment of superficial bladder cancer even if they have multiple chronic conditions, a new study suggests.

Treatment of superficial bladder cancer improves survival among older patients despite multiple chronic conditions (MCC), new study findings suggest.

“Currently, older adults with superficial bladder cancer may be subject to over- or undertreatment because it is hard to sort out who will benefit from transurethral resection or intravesical therapy due to concerns about competing chronic conditions,” lead investigator Tullika Garg, MD, MPH, of Geisinger Medical Center in Danville, Pennsylvania, told Renal & Urology News. “In our study, we found that older, medically complex patients with superficial bladder cancer derive an overall survival benefit from treatment, even within the context of multiple chronic conditions. However, this benefit was tempered by the strong association between multiple chronic conditions and death.”

Dr Garg and his collaborators studied 1800 patients aged 60 years or older, of whom 66.9% had MCC (2 or more chronic conditions at baseline). Patients who underwent bladder instillation and/or transurethral resection had a 30% decreased 10-year mortality risk compared with those managed with observation, the investigators reported in Cancer. After accounting for baseline chronic conditions, treatment was associated with a significant 34% decreased 10-year mortality risk.

Patients with MCC at baseline, however, had a 72% increased risk of death compared with those who did not.

“These data may help older bladder cancer patients and physicians to make personalized treatment decisions taking into account each individual's unique circumstances,” Dr Garg said.

The study population included patients receiving care at Geisinger and Kaiser Permanente Northwest (KPNW). At diagnosis, patients had a mean age of 73.6 years, with no significant difference in mean age between the treatment and observation arms (73.5 vs 74.1 years). Male patients made up nearly 79% of each group. Significantly more patients in the treatment arm than observation arm had MCC at baseline (70.4% vs 50.5%). The entire cohort had a median survival time of 7.8 years.

In a discussion of study strengths, the authors stated that, to their knowledge, their study is among the few to date to examine the association between cancer treatment and mortality in medically complex older adults. In addition, the study population was derived from 2 geographically disparate community-based health systems. “The large sample size with long-term follow-up allowed for robust analyses to accomplish the study objective,” they wrote.

The study also had limitations. Dr Garg's team noted that they were unable to determine why the observation group decided against treatment. They study also did not capture patients with lapses in insurance coverage or who sought treatment outside of the Geisinger or KPNW systems.

Reference

Garg T, Young AJ, O'Keeffe-Rosetti M, McMullen CK, et al. Association between treatment of superficial bladder cancer and 10-year mortality in older adults with multiple chronic conditions. Cancer. 2018; published online ahead of print.

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