Management of bladder cancer in older patients

Narita, Shintaro; Okita, Kazutaka; Narita, Takuma; Iwamura, Hiromichi; Fujita, Naoki; Inokuchi, Junichi; Matsui, Yoshiyuki; Kitamura, Hiroshi; Οhyama, Chikara

doi:10.1093/jjco/hyab187

Cited by 10 publications

(7 citation statements)

References 85 publications

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“…A sudden change in living environment is a major stress and risk factor for the development of delirium 15,16 . Moreover, standard treatment is not feasible in older patients with frailty because of their considerable comorbidities, frailty, and potential risk of experiencing adverse events 15–23 . In particular, poor prognosis due to undertreatment has also been reported for muscle‐invasive bladder cancer 21–23 .…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Moreover, standard treatment is not feasible in older patients with frailty because of their considerable comorbidities, frailty, and potential risk of experiencing adverse events. [15][16][17][18][19][20][21][22][23] In particular, poor prognosis due to undertreatment has also been reported for muscle-invasive bladder cancer. [21][22][23] With the increase in the number of older patients, invasive treatment for this population poses a challenge in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23] In particular, poor prognosis due to undertreatment has also been reported for muscle-invasive bladder cancer. [21][22][23] With the increase in the number of older patients, invasive treatment for this population poses a challenge in clinical practice. The impact of the increasing of life expectancy in this period needs to be debated.…”

Section: Discussionmentioning

confidence: 99%

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Trends in the age of hospitalized patients with urological cancers: A 17‐year experience

et al. 2023

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Objectives To investigate the impact of global aging on the trends in the age of hospitalized patients with a urological cancer diagnosis. Methods We retrospectively evaluated a cumulative total of 10 652 cases of referred patients (n = 6637) with a urological disease who were hospitalized in our institution between January 2005 and December 2021. We compared age and the proportion of patients aged ≥80 years among patients who were hospitalized in the urological ward between the period of 2005–2013 and that of 2014–2021. Results We identified 8168 hospitalized patients with urological cancer. The median age was significantly increased in patients with urological cancer between the periods of 2005–2013 and 2014–2021. The proportion of hospitalized patients with urological cancer aged ≥80 years was significantly increased between the periods of 2005–2013 (9.3%) and 2014–2021 (13.8%). The median ages of the patients with urothelial cancer (UC) and renal cell carcinoma (RCC), but not the median age of those with prostate cancer (PC), were significantly increased between the study periods. The proportion of hospitalized patients with UC, but not the proportions of those with PC and RCC, aged ≥80 years was significantly increased between the study periods. Conclusions The age of patients with urological cancer who were hospitalized in the urological ward and the proportion of patients with UC aged ≥80 years significantly increased over the entire study period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in the age of hospitalized patients with urological cancers: A 17‐year experience

et al. 2023

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“…Most elderly patients pose a substantial challenge to treatment because of the high incidence of complications and frail status. With the aging of society, the number of patients with bladder cancer will also increase and it is noteworthy that cardiovascular disease is a common illness among elderly patients, however a study found that cardiovascular disease was an independent protective factor for bladder cancer, but this effect was not observed in high-risk tumors ( 23 ), therefore, for such high risk tumor, to construct an effective assessment tool can help physicians make better decisions ( 24 ). In our analysis, the best cut-off value of age was obtained by x-tile software and age acted as the predictive factor of prognosis in patients with MBC.…”

Section: Discussionmentioning

confidence: 99%

Predictive nomograms for risk and prognostic factors in metastatic bladder cancer: a population-based study

Shi,

Peng,

Luo

et al. 2023

Transl Cancer Res

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Background Given the poor prognosis of patients with metastatic bladder cancer (MBC), the development of an effective diagnostic and prognostic model is significant in cancer management and for guidance in clinical practice. Methods We acquired data of 23,180 bladder cancer patients from Surveillance Epidemiology and End Results (SEER) database registered from 2010 to 2019. The optimal cut-off value for patient age and tumor size was determined by x-tile software. Independent risk factors for MBC were identified by univariate and multivariate logistic regression analyses and prognosis factors were identified by univariate and multivariate cox regression analyses, and risk and prognostic nomograms were constructed. The accuracy of the nomograms was verified by receiver operating characteristic (ROC) curves, calibration curves, and its clinical utility was determined by decision curve analysis (DCA) curves and clinical impact curves (CIC). Kaplan-Meier (K-M) survival curves further confirmed the clinical validity of the prognostic model. Results Through logistic regression analyses, we derived that age, histological type, tumor size, T stage, and N stage were independent risk factors for metastasis in bladder cancer patients. By cox regression analyses, age, chemotherapy, histological type, bone, lung and liver metastases were identified as risk factors influencing prognosis of MBC patients. Area under the curve (AUC) of the risk nomogram was 0.80, the AUC values of 1/2/3 years were 0.74/0.71/0.71 in the training group and 0.81/0.77/0.77 in the validation group. Based on calibration curves, DCA curves, CIC and K-M curves, the nomograms were validated with excellent predictive performance and clinical utility for MBC. Conclusions The nomograms we constructed have perfect predictive accuracy and clinical practicality for MBC patients, enabling clinicians to provide treatment advice and clinical guidance to patients.

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“…Older patients with cancer tend to have greater levels of frailty in comparison to individuals without cancer [ 17 ]. Furthermore, data (albeit limited) suggest that patients with kidney cancer, concurrent cancer with CKD, AKI with cancer, and/or treatment-associated nephrotoxicities most likely have worsened clinical outcomes with increased frailty [ 66 , 70 , 71 , 72 , 73 ]. Considering these factors, frailty status would be useful as a marker to guide clinical decision-making in onconephrology.…”

Section: Clinical Significance Of Frailty Assessment In Onconephrologymentioning

confidence: 99%

Is It Time to Integrate Frailty Assessment in Onconephrology?

Chinnadurai

Walker

et al. 2023

Cancers

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Onconephrology has emerged as a novel sub-specialty of nephrology dedicated to the intersection between the kidney and cancer. This intersection is broad and includes a number of important areas of focus, including concurrent chronic kidney disease (CKD) and cancer, acute kidney complications of cancer, and cancer-treatment-induced nephrotoxicity. The importance of onconephrology is even more evident when considering the global growth in the population of older adults, many of whom are living with some degree of frailty. Furthermore, a considerable proportion of older adults have CKD (some of whom eventually progress to kidney failure) and are at high risk of developing solid tumour and hematologic malignancies. Specific to kidney disease, the association between frailty status and kidney disease has been explored in depth, and tools to capture frailty can be used to guide the management and prognostication of older adults living with kidney failure. Whilst there is emerging data regarding the assessment and impact of frailty in onconephrology, there remains a relative paucity of knowledge within this topic. In this article, we evaluate the definition and operationalization of frailty and discuss the significance of frailty within onconephrology. We review evidence on current approaches to assessing frailty in onconephrology and discuss potential developments and future directions regarding the utilization of frailty in this patient population. A greater awareness of the intersections and interactions between frailty and onconephrology and further efforts to integrate frailty assessment in onconephrology to optimize the delivery of realistic and goal-directed management strategies for patients is needed.

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Management of bladder cancer in older patients

Cited by 10 publications

References 85 publications

Trends in the age of hospitalized patients with urological cancers: A 17‐year experience

Trends in the age of hospitalized patients with urological cancers: A 17‐year experience

Predictive nomograms for risk and prognostic factors in metastatic bladder cancer: a population-based study

Is It Time to Integrate Frailty Assessment in Onconephrology?

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