Research indicates that curative treatments are less frequently offered to patients over 70, highlighting the need to address the underuse of RC in older adults. A comprehensive geriatric assessment (CGA) is recommended to better guide treatment decisions, but its benefits in older adults with non-metastatic muscle-invasive bladder cancer (MIBC) have not fully been fully established. Winock et al. therefore conducted a retrospective study to tackle this knowledge gap.
A total of 86 patients were included in the study and were divided into three groups based on treatment: surgery (RC and neoadjuvant chemotherapy), non-surgical treatment (TMT with radiotherapy or chemotherapy), and no treatment (supportive care only). In patients who received surgery (n = 34), lymph node dissection was performed in 79.3% of patients. Early postoperative complications occurred in 73.5% of patients, with a mortality rate of 11.8% at 30 days and 23.5% at 90 days. Patients who did not receive any treatment were older, malnourished, and more likely to have cognitive decline. The G8 screening tool indicated that 94% of patients were candidates for CGA. Patients in the untreated group exhibited worse scores, indicating a higher need for CGA and lower overall health (p < 0.001). Polypharmacy was observed in 57.3% of all patients. Indices reflecting independence and daily living were significantly worse in patients who were untreated (p < 0.005). Median follow-up was 23.8 months (95% CI, 17.8 – 30.4) and the median overall survival was 9.5 months (95% CI, 5.2 – 16.0). There were no differences in survival across the treatment groups.
This study contributes to an important and relatively understudied area. The findings highlight the prognostic value of factors such as comorbidity and significant weight loss in this population. This in turn highlights the value of CGA in guiding treatment decisions. However, the study is limited by its retrospective design that led to relevant data being unavailable and the small sample size. Further prospective studies are needed to establish more specific and evidence-based guidelines for onco-geriatric care in elderly patients with localized muscle-invasive bladder cancer.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
Reference:
- Winock A, Mourey L, Gerard S, et al. Management of older patients with muscle invasive bladder cancer: A retrospective observational study. J Geriatr Oncol. Published online August 2, 2024. doi:10.1016/j.jgo.2024.101834.