Treating Elderly Patients With Muscle-Invasive Bladder Cancer

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Bladder cancer is an extremely common cancer that primarily affects individuals aged >65 years. In caring for patients with bladder cancer, clinicians must also consider care of older persons in general. Management of muscle-invasive bladder cancer (MIBC) involves multidisciplinary treatment planning, because curative-intent therapy includes either surgery or radiation, with consideration of the role of systemic therapy. As clinicians develop a treatment plan, considering a geriatric oncology perspective may enhance patient care and influence outcomes for this large and growing population. Similarly, treatment plan development must also consider aspects unique to an older patient population, such as altered organ function, increased comorbidity, decreased functional reserve, and perhaps altered goals of treatment. Thus a thorough evaluation inclusive of disease assessment and geriatric assessment is essential to care planning. Population-based data show that as patients with MIBC age, use of standard therapies declines. Given the complexities of coordinating a multidisciplinary care plan, as well the complexities of treating a heterogeneous and potentially vulnerable older patient population, clinicians may benefit from upfront assessments to inform and guide the process. This review highlights the unique treatment planning considerations for elderly patients diagnosed with MIBC.

Submitted November 18, 2019; accepted for publication May 4, 2020.

Disclosures: Dr. Kessler has disclosed that she has received research funding from Astellas, Bristol Myers Squibb, and Pfizer. The remaining authors have disclosed that they have no financial interests, arrangements, or affiliations with the manufacturers of any products discussed in this article or their competitors

Correspondence: Elizabeth R. Kessler, MD, Division of Medical Oncology, University of Colorado School of Medicine, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045. Email: Elizabeth.kessler@cuanschutz.edu
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