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Abstract Introduction Utilization of neoadjuvant chemotherapy (NC) in muscle invasive bladder cancer (MIBC) is increasingly recognized as standard of care but trends of use in Ontario remain unknown. Currently, there remains knowledge gaps regarding the effects of perioperative chemotherapy on the rates of interventions requiring hospitalization (IRH) and atheroembolic events (ATEs). Methods We conducted a population‐based retrospective study within the province of Ontario over 16 years. Patients with non‐metastatic MIBC receiving surgery only or planned for perioperative chemotherapy were included. Primary outcomes included 2‐year IRH and ATE rates. Univariate/multivariate analysis was used to identify predictors associated with IRHs and ATEs. Cochrane‐Armitage was used to assess treatment trends over time. Results Our study included 3281 patients. RC alone occurred in 2030 (60.9%), NC in 974 (29.6%) and adjuvant chemotherapy in 8.4% (n = 277). A total of 490/974 (50.3%) patients whom initiated NC with RC intent failed to undergo RC. This improved to 20.5% by 2015 (p

Summary: Roughly 50% of cancer cases occur in people aged 65 years or older. Older people are often diagnosed at a later stage and might receive less (intensive) treatment, which might affect the outcome. In addition, an older age might be associated with biological differences in tumour and microenvironment behaviour, a domain that has been poorly studied so far. In this narrative Review of published literature, we explored the reported differences in tumour biology according to age in five major cancer types: breast, colorectal, prostate, lung, and melanoma. Our literature search uncovered clear differences in tumour histology and subtype distribution in older people compared with younger patients, as well as age-specific patterns of tumour mutations and other molecular alterations. Several studies also indicate notable changes in tumour-infiltrating immune cells in tumours of older versus younger people, although this research is still in its infancy. More research is needed and might lead to a better understanding of the biology of ageing in relation to malignancy. This knowledge could provide new perspectives for more personalised cancer treatments, eventually improving the global outcomes of older patients with cancer.