Bladder cancer in the elderly patient: challenges and solutions

Elizabeth A Guancial,1 Breton Roussel,2 Derek P Bergsma,3 Kevin C Bylund,3 Deepak Sahasrabudhe,1 Edward Messing,4 Supriya G Mohile,1 Chunkit Fung1 1Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, 2Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, 3Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, 4Department of Urology, University of Rochester, Rochester, NY, USA Abstract: Bladder cancer (BC) is an age-associated malignancy with increased prevalence in the elderly population. Elderly patients are a vulnerable population at increased risk for treatment-related toxicity secondary to medical comorbidities and geriatric syndromes. As a result, this population has been historically undertreated and suffers worse disease-specific outcomes than younger patients with BC. Recognition of this disparity has led to efforts to individualize treatment decisions based on functional status rather than chronologic age in an effort to optimize the use of curative therapies for the fit elderly and modify treatments to reduce the risk of toxicity and disease-related morbidity in vulnerable or frail patients. The comprehensive geriatric assessment is a decision framework that helps to balance underlying health considerations and risks of therapy with aggressiveness of the cancer. Development of systemic therapies with increased efficacy against BC and reduced toxicity are eagerly awaited, as are techniques and interventions to reduce the morbidity from surgery and radiation for patients with BC. Keywords: bladder cancer, elderly, quality of life, surgery, radiation therapy, chemotherapy