title: Bladder cancer in the elderly patient: challenges and solutions.
abstract: Bladder cancer (BC) is an age-associated malignancy with increased prevalence in the elderly population. Elderly patients are a vulnerable population at increased risk for treatment-related toxicity secondary to medical comorbidities and geriatric syndromes. As a result, this population has been historically undertreated and suffers worse disease-specific outcomes than younger patients with BC. Recognition of this disparity has led to efforts to individualize treatment decisions based on functional status rather than chronologic age in an effort to optimize the use of curative therapies for the fit elderly and modify treatments to reduce the risk of toxicity and disease-related morbidity in vulnerable or frail patients. The comprehensive geriatric assessment is a decision framework that helps to balance underlying health considerations and risks of therapy with aggressiveness of the cancer. Development of systemic therapies with increased efficacy against BC and reduced toxicity are eagerly awaited, as are techniques and interventions to reduce the morbidity from surgery and radiation for patients with BC.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Guancial
authors.affiliation: Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Breton
authors.initials: B
authors.lastname: Roussel
authors.affiliation: Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Bergsma
authors.affiliation: Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Bylund
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sahasrabudhe
authors.affiliation: Department of Urology, University of Rochester, Rochester, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Messing
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Chunkit
authors.initials: C
authors.lastname: Fung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods; D002945:Cisplatin / Q000627:therapeutic use; D003071:Cognition; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods; D003657:Decision Making; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D009362:Neoplasm Metastasis; D011788:Quality of Life; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: bladder cancer; chemotherapy; elderly; quality of life; radiation therapy; surgery