It’s no surprise to learn that with advances in medicine and technology, individuals in the United States are living longer than ever before.1 However, as we age, we are more susceptible to developing aging-related conditions. 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.2 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, there are many treatment options available to this population that may be effective, so long as other factors have been considered.
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 go through changes and we are exposed to many things. Specifically, as we are living longer, we are being exposed to more carcinogens that can have a harmful effect on our body and our 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 a 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. Also, changes in our hormone levels, as well as the potential decline of various organ systems in our body that come with age may also pave the way for a cancer to develop and grow.2,3
What considerations should be made when navigating treatment options?
Oftentimes, the same treatment options are possible for an older individual with bladder cancer as a younger individual, however, not all of these treatment options may be as beneficial. In order to determine if a treatment option may be helpful in an older individual, it’s important for a physician or healthcare team to consider a variety of factors. Likewise, the individual choosing the treatment should also 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).
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 may be 85-years-old, but may run every day and have excellent mental and emotional health— another key component to handling aggressive treatment options and coping with potentially debilitating side-effects. Due to all of this, the 85-year-old individual may have an 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 important 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, if an individual’s cancer is slow-growing and they are in their 90’s, 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 the cancer would even be considered life-threatening. Further, if an individual does not have the means or support to get themselves to their treatment appointments because they can’t drive or they don’t have the ability to have a family member or driver transport them, 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 who is younger. While not everyone who is 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 important to communicate your wishes for treatment to your healthcare team, as well as to work with them as much as you can to develop a plan that’s right for you. If you are concerned about your ability to manage a particular side-effect, ask your doctor about how likely that side-effect is to happen to you, and make a plan of action in the event that it occurs. If you find there isn’t a way you agree with to manage a side-effect or potential life-change that could come with a treatment, that treatment may not be right for you.
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 that older individuals are not able to cope with more intense treatment options. If 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, it may be time to initiate an open conversation with them about what you’re looking for, or seek a new provider.
Overall, there are many treatment options that can be beneficial for individuals with bladder cancer, including those at an advanced age. One of the most important things to remember though, is that not all treatment options will be beneficial for everyone, and an idea of an individual’s overall health, regardless of their chronological age, should be considered.
Life expectancy increases globally as death toll falls from major diseases. Institute for Health Metrics and Evaluation. http://www.healthdata.org/news-release/life-expectancy-increases-globally-death-toll-falls-major-diseases. Accessed January 18, 2018.
Taylor JA, Kuchel GA. Bladder cancer in the elderly: Clinical outcomes, basic mechanisms, and future research direction. Nat Clin Pract Urol. Mar 2009; 6(3), 135-44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957872/. Accessed January 18, 2018.
Shariat SF, Milowsky M, Droller MJ. Bladder cancer in the elderly. Urol Oncol. Nov-Dec 2009; 27(6), 653-667. Available from: http://pubmedcentralcanada.ca/pmcc/articles/PMC4225777/. Accessed January 18, 2018.