Purpose: Elderly patients with muscle invasive bladder cancer often present treatment challenges due to concomitant comorbidities and psychosocial factors. This study examines patterns of treatment in this population and evaluates the impact of these factors on overall survival in a contemporary population.
Materials and methods: Common components of geriatric assessment were reviewed in 152 consecutive patients 70 years old or older presenting with nonmetastatic muscle invasive bladder cancer from January 1995 to December 2004 (median followup of 41 months). Overall survival was evaluated using Kaplan-Meier methods and a multivariate Cox model.
Results: Mean patient age was 76 years. Most patients underwent definitive treatment, with 114 (75%) opting for cystectomy including 29 of 114 (25%) with planned neoadjuvant chemotherapy. Only 15% were treated with palliative intent. Patients with a Karnofsky performance status of 80 or less or prior weight loss underwent bladder preservation more often than cystectomy (p <0.01). Overall survival was greatest in patients 80 years old or older compared to younger cohorts (p = 0.05) and in those treated with bladder preservation compared to other treatments (p = 0.04). In a multivariate analysis patients with a Karnofsky performance status of 80 or less had 1.8 times the risk of death compared to patients with a Karnofsky performance status of 90 or greater (95% CI 1.0-3.2, p = 0.05).
Conclusions: Most elderly patients with muscle invasive bladder cancer tolerate curative therapy. However, functional status must be seriously considered. Karnofsky performance status is an important predictor of overall survival in this population, with a Karnofsky performance status of 90 or greater providing a significant survival advantage regardless of treatment type. Thus, Karnofsky performance status should be routinely incorporated into treatment planning.