Surgery less likely in older bladder cancer patients
A new population-based study has found that patients 75 years of age or older with invasive bladder cancer are less likely to receive the recommended surgical treatment for the disease.
The findings "suggest in a sense some undertreatment of our older patients," Dr. Brenda K. Edwards of the National Cancer Institute, Bethesda, Maryland, told Reuters Health. However, she noted, the study was unable to gauge the influence of factors such as patient choice, which also could have made surgery less common among older patients.
According to a report in the journal Cancer, Edwards and her colleagues reviewed the medical records of 820 patients 55 years of age or older who were treated for bladder cancer in 1992.
While there was no difference in treatment based on age among patients with superficial disease, older patients with muscle invasion were less likely to be treated with radical cystectomy (surgical removal of the bladder). Only 14 percent of patients 75 or older had the surgery, compared with 48 percent of patients between 55 and 64, and 43 percent of those between 65 and 74.
At least 15 percent of patients in the study had a comorbid condition, such as heart disease, chronic pulmonary disease, or arthritis, while 38 percent were current or ex-smokers. But even after the scientists adjusted for comorbidity, age remained a factor in whether or not patients underwent surgery for bladder cancer.
In an editorial accompanying the study, Dr. Mark S. Soloway of the University of Miami points out that few community urologists are willing to perform radical cystectomy, given the demanding nature of the procedure as well as poor reimbursement.
"Only a few patients are not potential candidates for cystectomy, regardless of age or comorbidity," writes Dr. Joseph A. Smith Jr. of Vanderbilt University Medical Center, Nashville, Tennessee, in a second editorial.
"It is the job of the urologist and the oncologist to recognize when cystectomy is indicated and to promptly get the patients in the hands of an individual with substantial experience in performing radical cystectomy.".