Navigation Links
More intensive treatment not associated with better outcomes in early bladder cancer

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, according to a retrospective analysis published in the April 7 online issue of the Journal of the National Cancer Institute.

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 favor more intense surveillance and therapy, but individual urologists vary in their approach to treatment.

In the current study, Brent K. Hollenbeck, M.D., 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 hightreatment intensity style of practice was characterized by a greater use of all measured health services, including intravesical therapy, endoscopy, urinary studies, and imaging," the authors write. "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 lowtreatment intensity urologists, those treated by hightreatment 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."

In an accompanying editorial, Gary H. Lyman, M.D., and colleagues of Duke University School of Medicine in Durham, point out that retrospective studies based on healthcare claims need to be interpreted with caution. Important clinical information, which affects treatment decisions, may not be included in such databases. Additionally it is impossible to adjust for unmeasured factors which might influence the results. "The apparent association between provider treatment intensity defined as greater average bladder cancer expenditures and worse bladder cancerspecific but not overall survival is more likely the result of confounding by unavailable prognostic factors than the result of adverse events resulting from the procedures themselves," the editorialists write.


Contact: Caroline McNeil
Journal of the National Cancer Institute

Related medicine news :

1. Large intensive care study reveals vital recommendations for treatment of brain injury patients
2. Browns Wives Host Special Day at MetroHealth Medical Center to Support the Neonatal Intensive Care Unit
3. Smoking Cessation Rates Double With Intensive Counseling and Free Nicotine Replacement Therapy, Studies of 20,000 Smokers Show
4. Intensive care quality of sleep improved by new drug, reports study
5. Intensive training post-spinal cord injury can stimulate repair in brain and spinal cord
6. Susan G. Komen for the Cure Sharing Grassroots Advocacy Knowledge With International Representatives in Intensive Dallas Training Session
7. Intensive blood sugar treatment in trial of diabetes and cardiovascular disease changed
8. Construction Commencing at Gilbert Hospitals New Intensive Care Unit
9. Intensive care units prevention of pneumonia in critically-ill patients generally strong
10. Mayo Clinic Research Shows U.S. Intensive Care Units Prevention of Pneumonia in Critically-ill Patients Generally Strong; Identifies Area of Improvement
11. More intensive dialysis does not improve outcomes among patients with acute kidney injury
Post Your Comments:
(Date:6/25/2016)... ... June 25, 2016 , ... ... recover from injury. Recently, he has implemented orthobiologic procedures as a method for ... is one of the first doctors to perform the treatment. Orthobiologics are substances ...
(Date:6/24/2016)... ... 2016 , ... A recent article published June 14 on E ... goes on to state that individuals are now more comfortable seeking to undergo not ... as calf and cheek reduction. The Los Angeles area medical group, Beverly Hills Physicians ...
(Date:6/24/2016)... ... June 24, 2016 , ... Marcy was in a crisis. Her son James, eight, was ... his family verbally and physically. , “When something upset him, he couldn’t control his emotions,” ... He would throw rocks at my other children and say he was going to kill ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience with all areas ... , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct ...
(Date:6/24/2016)... ... June 24, 2016 , ... People across the U.S. are sharpening ... Talker Award, an essay contest in which patients and their families pay tribute to ... at the 2016 National Society of Genetic Counselors (NSGC) Annual Education Conference (AEC) this ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Research and Markets ... Market by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic ... Coating, Parenteral) - Global Forecast to 2021" report ... The global pharmaceutical excipients market is projected to ... of 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... Research and Markets has announced the ... 2016 - Forecast to 2022" report to their offering. ... up to date financial data derived from varied research sources ... with potential impact on the market during the next five ... comprises of sub markets, regional and country level analysis. The ...
(Date:6/23/2016)... 23, 2016 Bracket , a leading clinical ... generation clinical outcomes platform, Bracket eCOA (SM) 6.0, at ... 26 – 30, 2016 in Philadelphia , ... Outcome Assessment product of its kind to fully integrate with ... Bracket eCOA 6.0 is a flexible platform for electronic clinical ...
Breaking Medicine Technology: