Closer surveillance, treatment needed in bladder Ca

June 3, 2013

More intense surveillance and treatment in the first 2 years after a bladder cancer diagnosis could reduce the number of patients whose cancer recurs and lower the death rate from this disease, according to researchers from UCLA’s Jonsson Comprehensive Cancer Center.

More intense surveillance and treatment in the first 2 years after a bladder cancer diagnosis could reduce the number of patients whose cancer recurs and lower the death rate from this disease, according to researchers from UCLA’s Jonsson Comprehensive Cancer Center.

Their research also found that the burden of bladder cancer on the population is very high.

Based on previous UCLA research showing underutilization of care for patients with bladder cancer, the current study examined the natural history of the disease from a population standpoint. To date, no one has examined the morbidity of recurrence of disease in the United States, said lead author Karim Chamie, MD.

Dr. Chamie and colleagues found that nearly three-fourths of patients with high-grade, nonmuscle-invasive bladder cancer will suffer recurrence within 10 years. One-third of patients will have their cancers progress to a more advanced form requiring cystectomy, radiation therapy, or systemic chemotherapy. An additional 41% will recur without further disease progression.

“Even though 80% of bladder cancer patients don’t die of their disease within 5 years, most patients will either die of other causes or bladder cancer, require aggressive treatment (removal of the bladder, radiation, and/or chemotherapy), or have recurrence of their disease,” Dr. Chamie said. “What this study hopes to do is highlight the need to comply with treatment guidelines-prevent recurrences by instilling intravesical anticancer agents and follow patients more closely within the first 2 years of diagnosis.”

The study, reported online ahead of print in Cancer (June 4, 2013), was based on a nationwide sample of Medicare beneficiaries who had high-grade, nonmuscle-invasive bladder cancer.

“We have level-one evidence that demonstrates that a single instillation of chemotherapy into the bladder can minimize recurrences, and that six instillations can minimize recurrence and progression,” Dr. Chamie said. “Efforts should be increased to offer patients intravesical therapy with the goal of minimizing the burden of this disease.”

This study was supported by the American Cancer Society, Ruth L. Kirschstein National Research Service Award Extramural, Jonsson Comprehensive Cancer Center, National Institutes of Health, and National Institute of Diabetes and Digestive and Kidney Diseases.

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