“Journal Article of the Month” is a new Urology Times section in which Badar M. Mian, MD (left), offers perspective on noteworthy research in the peer-reviewed literature. Dr. Mian is professor of surgery in the division of urology at Albany Medical College, Albany, NY.
Bladder cancer is a disease of the elderly, with an average age at diagnosis of 73 years. The advanced age and significant comorbidities, which are often noted in patients with muscle-invasive bladder cancer (MIBC), can render some patients ineligible for curative therapy. In a new study, Westergren et al report that patients with MIBC who are not treated with curative intent require multiple hospitalizations and procedures related to bladder cancer in their last year of life (J Urol, May 30, 2019 [Epub ahead of print]).
To study the natural history of patients with invasive bladder cancer whose initial management did not include any treatment with curative intent (eg, radical cystectomy or chemoradiation), the authors analyzed the data captured in several Swedish national databases and registries. Between 1997 and 2014, they identified 9,811 patients with MIBC. Of these, 5,592 patients (57%) were initially managed without curative intent; ie, they were not treated with radical cystectomy or radiation therapy. In this study cohort, 68% were men and 32% were women.
Also by Dr. Mian: Renal mass biopsy safe, but when is it necessary?
Charlson comorbidity index was 0 or 1 in 68% of patients.
With a median age at diagnosis of 80 years, 55% of men and 62% of women with MIBC in this cohort did not receive initial treatment with curative intent. An average of 2.1 hospital admissions for 18.8 days per patient were recorded during the first year after diagnosis.
Bladder cancer-related morbidity was the primary reason for hospitalization in the vast majority of patients. These patients required multiple urologic procedures including transurethral resection of bladder tumor (32%), blood transfusions (18%), nephrostomy tubes (11%), palliative cystectomies (6%), and urinary diversion (7%).
Within 1 year of diagnosis, 63% of these patients with MIBC who did not receive curative treatment had died. The median overall survival was 8 months.
On multivariable analysis, tumor stage at diagnosis, older age, increased comorbidity, later year of diagnosis, and female gender increased the risk of death. The cancer-specific survival was 11 months (12 months for men; 9 months for women). Bladder cancer was recorded as the cause of death in 63% of cases.