Aging and Bladder Cancer Treatment

It's no surprise to learn that with advances in medicine and technology, individuals in the United States are living longer than ever before. However, as we age, we are more susceptible to developing aging-related conditions.¹

For example, cancer is a condition strongly associated with aging, specifically bladder cancer. As an individual's age increases, their risk of developing bladder cancer also rises. Whereas previously, receiving a major life-changing diagnosis at an advanced age may have meant limited options, now that more people are aging further, research is being done to investigate treatment outcomes at older ages. Being older and receiving a cancer diagnosis does not have to signal hopelessness. Instead, many treatment options available to this population may be effective, so long as other factors have been considered.²

Why are older individuals more likely to develop bladder cancer?

Although there is no set reason why an individual may develop bladder cancer at a certain age, there are some possible theories as to why it is more likely to receive a diagnosis later in life.

As we age, our bodies change and are exposed to many things. Specifically, as we live longer, we are exposed to more carcinogens that can harm our bodies and cells. Also, the repair mechanisms that our genes and cells use become less effective as we age. This means that not only are we being exposed to more cancer-causing entities, but we are not as able to fight them off. This can lead to significant damage. Additionally, the older we get, the more likely we are to have developed other co-morbid (or co-occurring) conditions. These conditions may make it easier for cancer to develop or for us to not be at our healthiest.^2,3

Further, as we age, our bodies experience more chronic inflammation. Inflammation, especially long-term inflammation, is a risk factor for developing cancer. Changes in our hormone levels, as well as the potential decline of various organ systems in our body that comes with age, may also pave the way for cancer to develop and grow.^2,3

What considerations should be made when navigating treatment options?

Often, the same treatment options are possible for an older individual with bladder cancer as a younger individual; however, not all of these options may be as beneficial. To determine if a treatment option may be helpful in an older individual, a physician or healthcare team needs to consider various factors. Likewise, the individual choosing the treatment should consider many things before deciding.

Getting the full picture

A full picture of an individual's physical, emotional, and mental health should be considered before making a choice. Co-morbid conditions may impact the way an individual is able to handle a treatment option, and may lead to dangerous side-effects.

Additionally, the overall functioning of the immune system should be considered before undergoing treatment options that may impact the body's immune response, such as chemotherapy, Bacillus Calmette-Guerin (BCG), or any other treatment that may require a long hospital stay. And thus, lead to a greater chance of developing an infection caused by being around others who are sick.

Overall fitness

Some experts have suggested, or even already use, tools that will provide an idea of an individual's overall fitness instead of relying on their age alone. For example, an individual maybe 85 years old but may run every day and have excellent mental and emotional health. Another critical component to handling aggressive treatment options and coping with potentially debilitating side effects.

Due to this, the 85-year-old individual may have overall health closer to that of a 60-year-old than someone at their actual chronological age. Conversely, a 60-year-old individual may have the overall fitness of a 90-year-old if they have severe mental or physical impairments. These factors are essential to consider.

Stage of cancer and individual circumstances

Also, factors like the stage of the cancer or how fast it is growing are critical to think about, as well as an individual's socioeconomic or familial support situation. For example, suppose an individual's cancer is slow-growing, and they are in their 90s. In that case, it may be best to forego invasive treatment options that could cause serious side effects, especially if they have a co-morbid condition that may lead to mortality before cancer would even be considered life-threatening.^2,3

Further, suppose an individual does not have the means or support to get to their treatment appointments because they can't drive or have a family member or driver transport them. In that case, a long-term option with regular visits may cause more stress than benefits.^2,3

How does age affect the treatment experience?

Advanced age may lead an individual to be more susceptible to debilitating side effects and the possibility of not being able to cope with these side effects as well as someone younger. While not everyone older will experience this, those who do may experience poorer outcomes, frustration, and the decline of other organ systems or structures in the body.^2,3

This is why it is vital to communicate your wishes for treatment to your healthcare team and work with them as much as possible to develop a proper plan. If you are concerned about your ability to manage a particular side effect, ask your doctor about how likely that side effect will happen to you, and make a plan of action. If you find there isn't a way you agree with to manage a side effect or potential life change that could come with treatment, that treatment may not be suitable for you.

Co-morbid conditions

More so than chronological age, an individual's overall fitness - mentally, emotionally, and physically, is important in predicting treatment experience, especially if an individual is already experiencing significant disability or is battling other co-morbid conditions.^2,3,

Not all providers will treat older individuals the same as younger individuals, and some may not think older individuals cannot cope with more intense treatment options. Suppose at any point you feel as though your doctor is not considering your wishes or is not considering your overall fitness rather than your actual age. In that case, it may be time to initiate an open conversation with them about what you're looking for, or seek a new provider.

Diagnosed with bladder cancer later in life

Overall, many treatment options can benefit individuals with bladder cancer, including those at an advanced age. One of the most important things to remember is that not all treatment options will help everyone, and an idea of an individual's overall health, regardless of chronological age, should be considered.