Challenging treatment decision-making in older urologic cancer patients

• Published in: World journal of urology 2014-04, Vol.32 (2), p.299-308
• Main Authors: Ploussard, Guillaume, Albrand, Gilles, Rozet, François, Lang, Hervé, Paillaud, Elena, Mongiat-Artus, Pierre
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma - therapy; Carcinoma, Renal Cell - therapy; Carcinoma, Transitional Cell - therapy; Decision Making; Disease Management; Female; Geriatric Assessment; Humans; Invited Review; Kidney Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Nephrology; Oncology; Prostatic Neoplasms - therapy; Quality of Life; Urinary Bladder Neoplasms - therapy; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-013-1158-4

Purpose Cancer is the leading cause of death among patients aged 65 years and older. In this population, the cancer diagnosis is often made at a more advanced stage and worse prognosis than in younger patients. Specific mortality in older patients is superior to that reported in their younger counterparts. Moreover, the impact of curative treatment that has proven benefit in overall population may be not well studied in the sub-group of older patients. Thus, the management of cancer in the elderly is a major public health concern in most Western countries. Methods/results In this review, we summarize this challenging treatment decision-making in older urologic patients with prostate, kidney or bladder cancer. The estimation of life expectancy remains a difficult task. Chronological age should not be considered as the main decisive factor anymore when considering aggressive cancer treatment. Comorbidities increase the complexity of cancer management and affect survival. Multidisciplinary evaluation and comprehensive geriatrics assessment using specific scales are critical to improve the treatment decision-making and to minimize both overtreatment of low-risk disease and undertreatment of high-risk disease. When an aggressive and potential quality-of-life-threatening treatment is scheduled after this comprehensive geriatrics assessment, personalized patient care must be early predefined by the geriatric team. Conclusions In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs.