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). CONCLUSION: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.

journal_name

Br J Cancer

authors

Noon AP,Albertsen PC,Thomas F,Rosario DJ,Catto JW

doi

10.1038/bjc.2013.106

subject

Has Abstract

pub_date

2013-04-16 00:00:00

pages

1534-40

issue

7

eissn

0007-0920

issn

1532-1827

pii

bjc2013106

journal_volume

108

pub_type

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