Intensive Early Treatment Doesn't Help Bladder Cancer Survival
TUESDAY April 7, 2009 -- More intensive treatment in the first two years after a diagnosis of early bladder cancer doesn't appear to improve patient survival, a new study finds.
Researchers analyzed data on 20,713 Medicare patients diagnosed with early bladder cancer between 1992 and 2002. The average cost of care for patients who received the most intensive treatment was $7,131 compared to $2,830 for those who received the least intensive treatment.
There was no association between more intensive treatment and better overall survival. The study also found that patients who had more intensive early treatment were more likely to undergo major interventions in the future.
"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," wrote Dr. Brent K. Hollenbeck, of the University of Michigan Health System in Ann Arbor, and colleagues, in a news release.
"However, this aggressive early treatment approach did not improve survival or prevent patients from having to undergo major medical interventions in subsequent years," Hollenbeck and colleagues noted. "In fact, compared with patients treated by low-treatment intensity urologists, those treated by high-treatment intensity urologists were nearly two-and-a 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."
The study appears in the April 7 online issue of the Journal of the National Cancer Institute.
The findings need to be interpreted with caution, Dr. Gary H. Lyman and colleagues at Duke University School of Medicine in Durham, N.C., wrote in an accompanying editorial.
"The apparent association between provider treatment intensity defined as greater average bladder cancer expenditures and worse bladder cancer-specific 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," Lyman and colleagues noted.