Older bladder cancer patients are less likely than younger patients to receive treatments intended to cure their disease such as surgery to remove the bladder or radiotherapy. But this difference cannot be fully explained by age, according to new research by scientists published in the British Journal of Cancer1.
Researchers, funded by Yorkshire Cancer Research at the University of Sheffield, looked at the records of around 3,300 bladder cancer patients diagnosed in Sheffield between 1994 and 2009. They wanted to investigate how age, type of bladder cancer and treatment affected the chances of surviving the disease2.
They found that 52 per cent of patients under 60 had potentially curative treatments such as surgery or radiotherapy, compared with 34 per cent of patients in their 70s and only 12 per cent of patients over 80.
And older patients over 70 were more likely to die of their bladder cancer than younger patients.
The researchers believe that the higher number of deaths in those over 70 is because these patients had a higher proportion of more aggressive tumours and were less likely to receive radical treatments such as radiotherapy or surgery to remove the bladder and nearby organs.
Mr James Catto, study author and consultant urological surgeon at the University of Sheffield, said: “Even though it appears that older patients are more likely to have aggressive tumours, our findings suggest that not enough older patients are being offered treatments that could increase their chance of survival.
“What’s very worrying is this conservative approach to treating older patients appears to be affecting the life expectancy of this group, something that doctors must work hard to combat.”
Dr Kathryn Scott, head of research funding at Yorkshire Cancer Research, said: “This research shows that the age of bladder cancer patients in Sheffield greatly affects how they are treated. This has a considerable effect on mortality rates in elderly bladder cancer patients and Yorkshire, along with the rest of the UK, is going to have to change to address this striking difference.”
Sarah Woolnough, executive director of policy and information at Cancer Research UK, said: “This study shows the older the patients are the less likely they are to be offered the kind of treatments that could cure their cancer.
“These decisions are never easy and need to be balanced with quality of life but it’s vital for patients of all ages to be given the option of a possible cure when it is still feasible.”
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1 Noon, A., Albertsen, P., Thomas, F., Rosario, D., & Catto, J. (2013). Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients British Journal of Cancer DOI: 10.1038/bjc.2013.106
2 All adult patients with primary bladder cancer were selected for inclusion (n=3,634). Those referred from other institutions for secondary opinions, those with histology other than bladder and those with inadequate follow up (<6 months) (n= 238) were excluded. Also excluded were cases in which the cause of death was unclear from the death certificate (for example when there was renal failure with coexisting bladder cancer) and not supported by post-mortem evidence (n=115).