TUESDAY, July 12 (HealthDay News) -- Most patients with a
certain type of bladder cancer don't get the recommended
treatments, which greatly increases their risk of experiencing a
recurrence of their disease, researchers say.
New research published online July 11 in
Cancer showed that just one of 4,545 people with high-grade,
noninvasive bladder cancer was treated according to the
comprehensive care guidelines set by the American Urological
Association and the National Comprehensive Cancer Network.
All of the patients had primary bladder cancer that had not yet
invaded their bladder muscle. These people have up to a 70 percent
chance of their cancer returning after treatment, and as much as a
50 percent chance of the cancer becoming more aggressive and
spreading to surrounding organs after initial treatment. Following
the treatment guidelines in full may protect patients from
potentially fatal cancer recurrences, the study authors said.
But the treatment guidelines are complex, and it's all or
nothing, said study author Dr. Karim Chamie, a postdoctoral fellow
in urologic oncology and health services research at the University
of California, Los Angeles Jonsson Comprehensive Cancer Center.
"You have to do it all or you might as well not do anything," he said.
When a patient has a high-grade cancer, it means the cells show
greater abnormality than cells from a low-grade tumor.
The guidelines for this grade of bladder cancer call for an
initial injection of chemotherapy drugs directly into the bladder
to kill cancer cells along with an intense follow-up surveillance
schedule that involves using a scope to assess the bladder
(cystoscopy) and urine testing (cytology) every three months. The
chemotherapy shot should be followed by a six-week course of
Bacillus Calmette-Guerin (BCG) treatment, which creates an
inflammatory response and causes the body to attack the bladder
cancer. Imaging of the upper urinary tract with a CT scan, MRI scan
or renal ultrasound is also recommended at diagnosis and every two
This would mean each patient receiving eight cystoscopy exams,
eight urine tests, two upper urinary tract imaging exams, one
chemotherapy shot and six BCG treatments in the two years after
their diagnosis, according to the report.
Compliance with the guidelines had little to do with the
patients' age, race or economic status. Instead, it was about the
doctors who were treating them, the researchers said. The
guidelines may not be reaching the urologists at community
hospitals, which is where the majority of people are treated, they
Full adherence to the recommendations "only happened for one
person in the study," Chamie said.
When researchers relaxed the standard to one cystoscopy, one
cytology and one injection of BCG during the two-year follow-up, 37
percent of patients received the recommended treatment, and just 58
percent of doctors followed these less-strict guidelines on any one
patient within two years.
Ongoing research suggests that following these comprehensive
care guidelines may confer a survival edge for people with bladder
cancer, he said.
Dr. H. Barton Grossman, professor and deputy chairman of the
urology department at M.D. Anderson Cancer Center in Houston, said
the guidelines described in the new study "are arbitrary and set
the bar too high so it looks like everyone failed."
That said, even when the study authors relaxed the standards,
they still were not met, Grossman said.
The authors' suggestions for boosting compliance rates included
modifying reimbursement rates and conducting additional research to
identify barriers to comprehensive treatment.
For more information on bladder cancer and its treatments, visit
American Cancer Society.