A new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society has reported that low compliance by healthcare providers to the current guidelines for the treatment of high-grade noninvasive bladder cancer is resulting in incomplete care of patients with the disease. The researchers believe that there is a need to recognize and overcome hurdles in order to provide the highest quality care to patients with bladder cancer.
Post treatment, high-grade noninvasive bladder cancer is known to recur and to progress to a more invasive tumor. Chance of recurring is up to 70% and of progression to more invasive form up to 50%. This makes optimal treatment for patients with the disease crucial. Subjects must undergo a number of surgeries if the tumor recurs in a noninvasive form. If the tumor returns in an invasive form, it can metastasize and spread to other parts of the body resulting in a risk of complete bladder removal along with radiation and chemotherapy treatments.
In order to reduce the chances of recurrence and progression of high-grade noninvasive bladder cancer, according to the current guidelines, anti-cancer drugs must be delivered using intravesical therapy directly to the bladder. Rigorous follow-up by conducting cytoscopy (endoscopy of the bladder) and cytology (a urine test) every three months is also advised.
Karim Chamie, MD, MSHS of the University of California Los Angeles and a team of researchers from UCLA's Jonsson Comprehensive Cancer Center conducted a study to find out whether the patients are actually receiving this recommended care. Data for 4,545 patients who were diagnosed with high-grade noninvasive bladder cancer for a period of 10 years (between 1992 and 2002) was collected by the researchers. The source of the data was the Surveillance, Epidemiology and End Results (SEER)-Medicare database. SEER is a source of information on cancer incidence and survival in the United States and links cancer registry information to a master file of Medicare enrollment.
Dr. Chamie said
"To our surprise, out of the 4,545 patients, only one received care that was compliant with all the guideline recommendations," "In addition, nearly half of urologists have not performed at least one cystoscopy, one cytology, and one instillation of intravesical therapy for any given patient in the first two years after diagnosis."
The results of the study have also revealed that the most important predictor of whether a patient underwent recommended care was the physician treating the patient. Patient factors, such as patients' age, race, socioeconomic status, severity of other medical conditions, and extent of their bladder cancer did not play any significant role in contributing to the low compliance rate of healthcare providers with guideline recommendations.
Authors of the study have stated that further research needs to be carried out to identify why most of the doctors are not following medical guidelines related to bladder cancer.
Dr. Chamie said, that based on these findings:
"..one would deduce that more than 99 percent of patients with high-risk bladder cancer are not receiving recommended care. This is significantly less than what most patients with bladder cancer, their physicians, and policy makers believe is happening. We hope that shedding light on the level of discordance between ideal and routine care will prompt policy makers to modify reimbursement policies or support quality-improvement initiatives in the future."
"Compliance with guidelines for patients with bladder cancer: variation in the delivery of care."
Karim Chamie, Christopher S. Saigal, Julie Lai, Jan M. Hanley, Claude M. Setodji, Badrinath R. Konety, Mark S. Litwin, and the Urologic Diseases in America Project.
CANCER. Published Online: July 11, 2011 (DOI: 10.1002/cncr.26198).
Written by Barry Windsor