Bladder cancer: international recommendation for management in older patients

  • Mottet N & al.
  • J Geriatr Oncol
  • 10 Feb 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • The International Society of Geriatric Oncology (SIOG) task force has released recommendations for management in older patients.

Key recommendations

  • Nonmuscle invasive bladder cancer:
    • Treat with standard therapy according to accepted national/international guidelines.
    • Avoid anticholinergics to manage the adverse effects of intravesical therapy where possible; use with caution if needed.
  • Muscle invasive bladder cancer:
    • Cross-sectional imaging should be performed in all patients for staging and identifying bone disease and to optimize the best supportive care regardless of age and fitness.
    • If radical cystectomy is decided on, refer patient to an experienced center.
    • Prehabilitation for surgery includes enhancing nutrition and fitness and treatment of anemia to avoid unduly delay in surgery (strong).
    • Consider radiotherapy or transurethral resection of a bladder tumor alone when the patient refuses or is unfit for standard treatment (strong).
  • Metastatic bladder cancer:
    • Discuss prognosis and goals of care with patients and caregivers; consideration of appropriate palliation should begin at the time of diagnosis.
    • First-line should be standard systemic therapy, but this will depend primarily on fitness for cisplatin and on prognostic factors.
    • Consider carboplatin for cisplatin-unfit and immunotherapy for PD-L1-positive patients.
    • Consider standard second-line immunotherapy in platinum-pretreated patients.
    • Consider palliative radiotherapy for intractable gross hematuria and control of pain.