Aggressive treatment rates low in bladder cancer
medwireNews: Aggressive treatment (AT) for muscle-invasive bladder cancer (MIBC) could be being underused, according to a US study that assessed its use among almost 30,000 patients.
While the AT rate was just over half, at 53%, its use decreased with advancing patient age, among racial minorities, the uninsured, and Medicaid insured, and at low treatment-volume centers.
Indeed, the findings point toward a "significant unmet need to inform policy makers, payers, and physicians," remark the researchers.
Reporting their findings in European Urology, William Shipley (Massachusetts General Hospital, Boston) and colleagues assessed data for 28,691 patients with American Joint Committee on Cancer stage II-IV cancer of the urinary bladder who were treated between 2001 and 2008.
In all, 45% of patients underwent surgical treatment, while definitive radiotherapy (RT) with additional chemotherapy (CT) was used in 5.3% of cases, and RT alone in 3.8% of cases. A total of 10% of patients received CT alone, and 26% underwent observation only.
Overall, 53% of these therapies were considered to be AT, defined as "any therapy with a reasonable likelihood of providing cure," explain Shipley et al.
They note that one of the most "striking" findings was the high rate of observation, which carries a high risk for recurrence in MIBC patients. A quarter of patients aged 70-79 years were treated this way, and almost half of those aged 80-89 years. "Age alone" should not disqualify these patients from receiving potentially curative therapy, writes the team.
AT was more likely among younger than older patients, with patients aged 81-90 years 66% less likely to receive such treatment than patients aged 50 years or younger.
Furthermore, being a Black patient (vs White), having no insurance, being a Medicaid beneficiary, or a young Medicaid patient significantly reduced the odds for receiving AT, by a respective 26%, 27%, 19%, and 14%.
"The finding that younger Medicare patients were less likely to receive RT may be related to the high level of disability required to obtain Medicare coverage before age 65 years," speculate the authors.
Being treated with AT was also significantly less likely at low- or medium-volume centers compared with high-volume ones, at odds ratios of 0.64 and 0.74, respectively.
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By Sarah Guy, medwireNews Reporter