Costly High Intensity Treatment for Early-stage Bladder Cancer Proves Ineffective for Many Patients

Urologists need to reassess how they treat early-stage bladder cancer because high-intensity methods are too costly and don't affect overall mortality, concluded Brent K. Hollenbeck, M.D., et al., in "Provider Treatment Intensity and Outcomes for Patients with Early-stage Bladder Cancer," published in the April 7, 2009, Journal of the American Cancer Institute.

Survival rates were similar across all intensity categories when the authors studied the Surveillance, Epidemiology and End Results (SEER) Medicare database of 20,713 patients diagnosed with early stage bladder cancer from 1992 to 2002. This held true even though the average highest Medicare expenditure per patient at $7,131, was more than twice the cost, $2,830, of the lowest cost treatment regimen.

The high-intensity treatment providers were more likely to perform endoscopic surveillance and used more intravesical therapy, according to Hollenbeck et al. The early intensive treatment also did not prevent later major treatment intervention.

"Providers vary widely in how aggressively they manage early-stage bladder cancer," stated the authors. "Patients treated by high treatment intensity providers do not appear to benefit in terms of survival or in avoidance of subsequent major medical interventions."

According to the National Cancer Institute, treatment for stage I bladder cancer may include: transurethral resection with fulguration; resection and fulguration followed by intravesical biologic therapy or chemotherapy; segmental or radical cystectomy; and radiation implants with or without external radiation therapy. External radiation combined with chemotherapy may be prescribed in stages II through IV, according to the NIH at http://www.cancer.gov/cancertopics/pdq/treatment/bladder.

Patients in this study who were treated with aggressive options were more likely to have additional imaging and surgical procedures, and were 2.5 percent more likely to undergo bladder removal.

Hollenbeck noted that reducing aggressive treatments for early-stage bladder cancer also could help patients and insurers pay for what is one of the most expensive, long-term cancers, according to a press release from the University of Michigan Health System Newsroom. This study can be accessed at http://jnci.oxfordjournals.org.