title: Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients.
abstract: BACKGROUND
  Bladder cancer (BC) predominantly affects the elderly and is often the cause of death among patients with muscle-invasive disease. Clinicians lack quantitative estimates of competing mortality risks when considering treatments for BC. Our aim was to determine the bladder cancer-specific mortality (CSM) rate and other-cause mortality (OCM) rate for patients with newly diagnosed BC.
  
  
  METHODS
  Patients (n=3281) identified from a population-based cancer registry diagnosed between 1994 and 2009. Median follow-up was 48.15 months (IQ range 18.1-98.7). Competing risk analysis was performed within patient groups and outcomes compared using Gray's test.
  
  
  RESULTS
  At 5 years after diagnosis, 1246 (40%) patients were dead: 617 (19%) from BC and 629 (19%) from other causes. The 5-year BC mortality rate varied between 1 and 59%, and OCM rate between 6 and 90%, depending primarily on the tumour type and patient age. Cancer-specific mortality was highest in the oldest patient groups. Few elderly patients received radical treatment for invasive cancer (52% vs 12% for patients <60 vs >80 years, respectively). Female patients with high-risk non-muscle-invasive BC had worse CSM than equivalent males (Gray's P<0.01).
  
  
  CONCLUSIONS
  Bladder CSM is highest among the elderly. Female patients with high-risk tumours are more likely to die of their disease compared with male patients. Clinicians should consider offering more aggressive treatment interventions among older patients.
authors.affiliation: The Academic Urology Unit and Institute for Cancer Studies, G Floor, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2JF, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Noon
authors.forename: P C
authors.initials: PC
authors.lastname: Albertsen
authors.forename: F
authors.initials: F
authors.lastname: Thomas
authors.forename: D J
authors.initials: DJ
authors.lastname: Rosario
authors.forename: J W F
authors.initials: JW
authors.lastname: Catto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery