TY - JOUR
T1 - Association between treatment of superficial bladder cancer and 10-year mortality in older adults with multiple chronic conditions
AU - Garg, Tullika
AU - Young, Amanda J.
AU - O’Keeffe-Rosetti, Maureen
AU - McMullen, Carmit K.
AU - Nielsen, Matthew E.
AU - Kirchner, H. Lester
AU - Murphy, Terrence E.
N1 - Funding Information:
Tullika Garg, Amanda J. Young, and Terrence E. Murphy report grant support from the National Institute on Aging for work performed as part of the current study. Matthew E. Nielsen has acted as a paid consultant for the High Value Care Task Force for the American College of Physicians; received grants from the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Patient-Centered Outcomes Research Institute; and acted as a paid member of the medical advisory board for Grand Rounds for work performed outside of the current study.
Funding Information:
Supported by the Health Care Systems Research Network (HCSRN)?Older Americans Independence Center (OAICs) AGING Initiative (grant R24AG045050) and the Yale Claude D. Pepper Older Americans Independence Center (grant P30AG021342; Principal Investigator: Gill).
Funding Information:
Supported by the Health Care Systems Research Network (HCSRN)–Older Americans Independence Center (OAICs) AGING Initiative (grant R24AG045050) and the Yale Claude D. Pepper Older Americans Independence Center (grant P30AG021342; Principal Investigator: Gill).
Publisher Copyright:
© 2018 American Cancer Society
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: Multiple chronic conditions (MCC) are common among older patients with cancer; however, the exclusion of these patients from clinical trials has resulted in scarce knowledge concerning outcomes, resulting in variations in treatment. Superficial bladder cancer (SBC) disproportionately affects older adults, yet to the authors’ knowledge few studies to date have examined whether treatment improves long-term survival. In the current study, the authors evaluated the association between treatment of SBC and 10-year mortality in medically complex older adults. Methods: The authors identified 1800 older (aged ≥60 years) patients with SBC (American Joint Committee on Cancer stage ≤I) from 2 community-based health systems who received treatment (bladder instillation and/or transurethral resection) or observation. Cox proportional hazards regression was performed adjusting for age, sex, race, health system, stage of disease/grade, and MCC (≥2 baseline chronic conditions). Propensity score analysis using stabilized inverse probability of treatment weights was used to compare 10-year mortality in the 2 treatment groups with adjustment for covariates. Results: Overall, 1485 patients (82.5%) and 315 patients (17.5%) received treatment and observation, respectively. In unweighted multivariable analysis, treatment was associated with a 30% reduction in death (adjusted hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.58-0.85 [P<.01]) and MCC with a 72% increase in death (adjusted HR, 1.72; 95% CI, 1.44-2.05 [P<.01]). Weighted analysis with adjustment (doubly robust) also demonstrated a survival benefit for treatment (adjusted HR, 0.66; 95% CI, 0.52-0.84 [P<.01]). Conclusions: The results of the current study demonstrated a clinically meaningful association between cancer treatment and survival benefit in older, medically complex patients with SBC, even after adjustment for medical complexity. These data provide a foundation for future work aimed at personalizing the treatment guidance of older patients with cancer with MCC.
AB - Background: Multiple chronic conditions (MCC) are common among older patients with cancer; however, the exclusion of these patients from clinical trials has resulted in scarce knowledge concerning outcomes, resulting in variations in treatment. Superficial bladder cancer (SBC) disproportionately affects older adults, yet to the authors’ knowledge few studies to date have examined whether treatment improves long-term survival. In the current study, the authors evaluated the association between treatment of SBC and 10-year mortality in medically complex older adults. Methods: The authors identified 1800 older (aged ≥60 years) patients with SBC (American Joint Committee on Cancer stage ≤I) from 2 community-based health systems who received treatment (bladder instillation and/or transurethral resection) or observation. Cox proportional hazards regression was performed adjusting for age, sex, race, health system, stage of disease/grade, and MCC (≥2 baseline chronic conditions). Propensity score analysis using stabilized inverse probability of treatment weights was used to compare 10-year mortality in the 2 treatment groups with adjustment for covariates. Results: Overall, 1485 patients (82.5%) and 315 patients (17.5%) received treatment and observation, respectively. In unweighted multivariable analysis, treatment was associated with a 30% reduction in death (adjusted hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.58-0.85 [P<.01]) and MCC with a 72% increase in death (adjusted HR, 1.72; 95% CI, 1.44-2.05 [P<.01]). Weighted analysis with adjustment (doubly robust) also demonstrated a survival benefit for treatment (adjusted HR, 0.66; 95% CI, 0.52-0.84 [P<.01]). Conclusions: The results of the current study demonstrated a clinically meaningful association between cancer treatment and survival benefit in older, medically complex patients with SBC, even after adjustment for medical complexity. These data provide a foundation for future work aimed at personalizing the treatment guidance of older patients with cancer with MCC.
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U2 - 10.1002/cncr.31705
DO - 10.1002/cncr.31705
M3 - Article
C2 - 30289971
AN - SCOPUS:85054513389
SN - 0008-543X
VL - 124
SP - 4477
EP - 4485
JO - Cancer
JF - Cancer
IS - 23
ER -
