Bladder cancer in the elderly patient: challenges and solutions

Figures & data

Table 1 Relative exclusion criteria for treatment with cisplatin in patients with metastatic bladder cancer

Any one of the following:

ECOG PS ≥2, or KPS 60%–70%

Creatinine clearance <60 mL/min

CTCAE v4 grade 2 or greater peripheral neuropathy

Grade 2 or greater audiometric hearing loss

NYHA class III or greater heart failure

Note: Data from Galsky et al.⁴⁰

Abbreviations: CTCAE, Common Terminology Criteria for Adverse Events; ECOG PS, Eastern Cooperative Oncology Group Performance Status; KPS, Karnofsky Performance Status; NYHA, New York Heart Association.

Table 2 Risk factors for chemotherapy toxicity in the elderly

Age ≥72 years

Cancer type (gastrointestinal or genitourinary)

Standard dosing of chemotherapy

Polychemotherapy

Hemoglobin (males <11 g/dL; females <10 g/dL)

Creatine clearance <34 mL/min

Hearing impairment

At least one fall in the last 6 months

Limited in walking one block

Need for assistance in taking medications

Decreased social activities because of physical or emotional health

Note: Data from Montgomery et al.³⁵

Table 3 Geriatric assessment and measurement options

Domains	Definition	Measurement options
Function/physical performance	Ability to take care of one’s own needs to live independently at home Ability to care for tasks that allow independence in the community Physical performance is an objective evaluation of mobility, balance, and fall risk	Activities of daily living Instrumental activities of daily living History of falls Timed Up and Go test Short Physical Performance Battery Handgrip testing
Comorbidity/pharmacy	Chronic diseases that influence life expectancy and may influence tolerance to cancer treatment Medications can increase risk of adverse events with cancer treatment	Charlson Comorbidity Index Cumulative Illness Scale-Geriatrics Comorbidity count and severity Medication count Beers criteria
Cognition	Common in older patients and may affect decision-making capacity and interfere with cancer treatment	Mini-Mental State Examination Blessed-Orientation-Memory Scale Short Portable Mental Status Questionnaire Montreal Cognitive Assessment
Psychological status	Depression and anxiety are independently associated with adverse outcomes in cancer patients	Geriatric Depression Scale Hospital Anxiety and Depression Scale
Nutrition	Weight loss and anorexia affect tolerance to treatment and survival in older cancer patients	Mini-Nutritional Assessment Weight loss Body mass index
Social support	Adequate social support necessary for older patients to successfully undergo treatment	Needs assessment of financial capabilities, transportation, and caregiver status Medical Outcomes Survey Social Support

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