Bladder cancer is considered an age-related type of cancer. More than 3 out of 4 people diagnosed with bladder cancer are over the age of 65. About 44 percent of people diagnosed with bladder cancer are over the age of 75 — the common cut-off age for those who are considered to be elderly.

Your age isn’t the most important consideration when choosing the best treatment for bladder cancer. However, older adults are more likely to have health conditions that could affect treatment. This article covers how age-related health problems can affect bladder cancer treatment in older adults.

Health Problems in Older Adults

Old age isn’t a disease — it’s a natural part of life. However, as you grow older, your body changes, and these changes can make you more likely to develop certain health issues. Research from the National Council on Aging found that almost 95 percent of people over the age of 60 have at least one chronic (long-term) health condition, and most have two or more. Having more than one medical condition at a time is known as having comorbidities.

Common age-related comorbidities include:

• Hypertension (high blood pressure)
• Obesity
• Heart disease
• Diabetes
• Chronic kidney disease (CKD)
• Depression
• Alzheimer’s disease and dementia

Health conditions like these can affect how well you recover from other illnesses, such as bladder cancer. Research has found that age and comorbidities can predict overall survival (how long you live) in people with bladder cancer. Age-related comorbidities may impact your ability to tolerate certain bladder cancer treatments. Additionally, people with a history of smoking — a known risk factor for bladder cancer — are also more likely to have health problems that can complicate bladder cancer treatment.

Health Evaluation for Older Adults Before Bladder Cancer Treatment

After a bladder cancer diagnosis, a team of healthcare providers will perform tests to better understand how bladder cancer treatments may affect you. Recognizing and properly managing common geriatric syndromes — conditions that older people tend to develop, such as delirium, gait imbalance (trouble walking), malnutrition, and incontinence — is an important part of your comprehensive treatment plan. Health experts recommend that everyone over the age of 70 with bladder cancer undergo a comprehensive geriatric assessment.

During this assessment, a team of specialists will evaluate several aspects of your health, including:

• Your ability to take care of yourself — Can you do daily tasks like dressing, bathing, and cooking on your own?
• Your physical fitness — How strong and active are you?
• Your risk of falling — Do you have trouble balancing or walking without help?
• Your comorbidities — Do you have other health conditions, like diabetes or heart disease?
• Your medications — Are you using any medications that could affect your treatment?
• Your ability to make decisions — Can you understand and make choices about your treatment?
• Your mental health — Are you feeling emotionally well, or are you feeling depressed or anxious?
• Your diet — Are you getting enough nutrients from your food?
• Your social support network – Do you have family or friends to help and support you?

After this assessment, your cancer care team will have a better understanding of whether you’re fit enough for certain bladder cancer treatments, such as surgery and chemotherapy. You’re generally considered fit for treatment if you’re able to take care of yourself and don’t have any significant comorbidities. In general, people who are fit for treatment can receive standard treatment for bladder cancer, no matter their age.

If you have difficulty moving around by yourself, a history of falls, or multiple comorbidities, your healthcare team must weigh your treatment options against the potential for serious side effects and a decrease in quality of life.

Bladder Cancer Treatment Considerations for Older Adults

The goal of bladder cancer treatment is to find the most effective treatment with the fewest side effects. Some of the factors your cancer care team will consider when suggesting treatment include:

• Your fitness for treatment – How healthy are you overall?
• Your symptoms – How bad are your symptoms, like pain or trouble urinating?
• Your treatment goal – Are you trying to get rid of the cancer completely or just manage symptoms so you feel better?
• Your life expectancy after treatment – How long do doctors expect you to live after treatment?

It can be difficult to know how some treatments will affect older adults. Although bladder cancer is more common in older adults, this group is often left out of clinical trials. This means that there is limited data about how older adults react to certain treatments.

Below are some of the special considerations for different bladder cancer treatment options in older adults.

Surgery

Bladder cancer surgery is a common treatment option for people diagnosed with bladder cancer. The two main types of surgery used to treat bladder cancer are:

• Transurethral resection of bladder tumor (TURBT)
• Radical cystectomy (bladder removal surgery)

TURBT is typically used to remove smaller tumors from the bladder, while radical cystectomy involves removing the entire bladder. Radical cystectomy is the more invasive of the two surgeries and is often recommended for people with muscle-invasive bladder cancer (MIBC), which means the cancer has spread into the muscle of the bladder wall.

Older adults are less likely to need a cystectomy than younger people. This is especially true in people with multiple health problems. Although radical cystectomy is the recommended treatment for people with MIBC, this treatment can be risky for older adults. Studies have shown that older adults are more likely to die within 90 days of surgery compared to younger people. Newer surgical methods, such as robot-assisted surgery, may help improve the safety of surgery. However, there still aren’t many studies on older adults.

Older adults may be more likely to experience incontinence (inability to control the flow of urine) after a urinary diversion (rerouting the flow of urine out of the body). Because of this, doctors often recommend that older adults get an incontinent diversion approach, such as an ileal conduit. This type of urinary diversion requires you to wear a bag attached to your stomach to collect urine, which may not be preferable for some people.

Chemotherapy

Chemotherapy is a common treatment to shrink bladder cancer tumors. People can receive either neoadjuvant chemotherapy (which they get before surgery) or adjuvant chemotherapy (which they get after surgery).

Some of the most common chemo drugs used to treat bladder cancer include:

• Cisplatin (Platinol)
• Carboplatin (Paraplatin)
• Docetaxel (Taxotere)
• Gemcitabine (Infugem)
• Paclitaxel (Taxol)

Side effects of these drugs can include:

• Nausea
• Vomiting
• Loss of appetite
• Mouth sores
• Diarrhea
• Constipation
• Hair loss
• Increased risk of infection
• Easy bleeding or bruising, even after minor cuts or injuries
• Fatigue

Several age-related comorbidities — such as CKD, diabetes, and heart disease — can increase the likelihood of experiencing kidney damage from chemotherapy drugs. The risk of serious chemo side effects is higher in older adults with:

• Poor kidney function
• Anemia (low counts of red blood cells)
• Hearing loss
• History of falls
• Poor physical fitness
• Lack of social support

These side effects are also more pronounced in adults older than 72.

Radiation Therapy

Radiation therapy can help shrink bladder cancer tumors and improve bladder cancer symptoms. Radiation therapy can also be used after surgery to kill any remaining cancer cells — this process is known as adjuvant therapy. Adjuvant therapy is usually well tolerated by older adults. It is a good option for people who are too fragile for surgery and for those who would prefer to avoid surgery.

Radiation therapy is most effective among people whose MIBC hasn’t spread to the lymph nodes or other parts of the body. It’s also effective in managing bladder cancer symptoms, such as hematuria (blood in the urine), painful urination, and frequent urination. In some cases, radiation can also help relieve pain caused by cancer spreading to nearby tissues or organs.

Side effects of radiation therapy can include fatigue, skin irritation, and changes in bowel or urinary function. These side effects are often temporary and can be managed with your healthcare team’s help.

Immunotherapy and Targeted Therapy

Immunotherapy helps the body’s immune system fight cancer by using medicines that either boost the immune response or help the immune system recognize cancer cells. Targeted therapy blocks specific molecules involved in cancer cell growth and survival to stop the cancer from spreading.

Considerations for immunotherapy and targeted therapies are different because the side effects of these treatments tend to be different from chemotherapy. Additionally, older adults were included in clinical trials for these drugs, meaning there is more information about how older adults tolerate these medications.

The immunotherapy drugs currently approved for bladder cancer — avelumab (Bavencio), nivolumab (Opdivo), and pembrolizumab (Keytruda) — showed no differences in safety or efficacy in older adults compared to younger people. This suggests that immunotherapy may be a good option for older adults because it is well tolerated and works similarly in younger and older people.

In clinical trials for the targeted therapy drug, erdafitinib (Balversa), there weren’t any differences in how well the drug worked in older adults. However, older adults were more likely to have to stop taking it due to side effects.

It’s important to remember that everyone is different, and treatment decisions should be based on your specific health needs, cancer stage, and personal preferences. Your cancer care team can help you understand the risks and benefits of these medications.

Talk With Your Cancer Care Team

Research from the American Cancer Society and the National Cancer Database report that curative treatments for bladder cancer aren’t used as often as they could be in older adults. Your chronological age alone doesn’t exclude you from any type of treatment. Talk to your cancer care team about how to tailor your bladder cancer treatment regimen so you can be part of the decision-making process.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

How did your age factor into your decision about your treatment options? Share your experience in the comments below, or start a conversation by posting on your Activities page.