Management of bladder cancer in older patients: Position paper of a SIOG Task Force

Publication date: Available online 10 February 2020Source: Journal of Geriatric OncologyAuthor(s): Nicolas Mottet, Maria J. Ribal, Helen Boyle, Maria De Santis, Philippe Caillet, Ananya Choudhury, Tullika Garg, Matthew Nielsen, Patrick Wüthrich, Kilian M. Gust, Shahrokh F. Shariat, Georgios GakisAbstractMedian age at bladder cancer (BC) diagnosis is older than for other major tumours. Age should not determine treatment, and patients should be fully involved in decisions. Patients should be screened with Mini-Cog™ for cognitive impairment and the G8 to ascertain need for comprehensive geriatric assessment. In non-muscle invasive disease, older adult patients should have standard therapy. Age does not contraindicate intravesical therapy. Independent of age and fitness, patients with muscle-invasive BC should have at least cross-sectional imaging. Data suggest extensive undertreatment in older adult patients, leading to poor outcomes. Standard treatment for a fit patient differs between countries. Radical cystectomy and trimodality therapy are first-line options. Radical cystectomy patients should be referred to an experienced centre and prehabilitation is mandatory. Older adult patients should be considered for neoadjuvant and adjuvant therapy, according to guidelines. In urinary diversion, avoiding bowel surgery for reconstruction of the lower urinary tract significantly reduces complications. If a patient is unfit for or refuses standard treatment, RT alone, or TURBT in se...
Source: Journal of Geriatric Oncology - Category: Cancer & Oncology Source Type: research