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Early bladder cancer: more intensive treatment not associated with better outcomes


Patients with early bladder cancer who receive more intensive treatment within the first two years of diagnosis do not appear to have better survival than patients who receive less intensive treatment.

Although bladder cancer is the fifth most common cancer in the United States, optimal treatment strategies for the disease remain unclear and there are relatively few data available from randomized controlled clinical trials. Current treatment guidelines favour more intense surveillance and therapy, but individual urologists vary in their approach to treatment.

In the current study, Brent K. Hollenbeck, of the University of Michigan Health System in Ann Arbor, and colleagues used the Surveillance, Epidemiology, and End Results database and linked patient information in the Medicare database to determine whether more intensive early treatment was associated with better outcomes. The investigators identified 20,713 patients diagnosed with early bladder cancer between 1992 and 2002. They estimated the intensity of treatment based on Medicare costs in the first two years following diagnosis and then divided the 940 treating physicians into four groups based on their average cost of treatment.

The average cost of care for early bladder cancer was $2,830 in the least treatment-intense group compared with an average cost of $7,131 in the most treatment-intense groups. More intensive treatment was not associated with better overall survival. Patients who underwent more intensive early treatment were more likely to undergo major interventions later.

The high–treatment intensity style of practice was characterized by a greater use of all measured health services, including intravesical therapy, endoscopy, urinary studies, and imaging. However, this aggressive early treatment approach did not improve survival or prevent patients from having to undergo major medical interventions in subsequent years. In fact, compared with patients treated by low-treatment intensity urologists, those treated by high-treatment intensity urologists were nearly two and one-half times more likely to undergo radical cystectomy and nearly twice as likely to receive any major medical intervention, even after accounting for patient differences.

Source: Journal of the National Cancer Institute, 2009

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