Aggressive treatment doesn't improve survival

Despite enduring more invasive tests and medical procedures, patients who were treated aggressively for early stage bladder cancer had no better survival than patients treated less aggressively. Further, aggressively treated patients were more likely to undergo major surgery to have their bladders removed, according to a new study from researchers at the Comprehensive Cancer Center.

Because bladder cancer often is treated as a chronic disease requiring lifelong surveillance, it is among the most expensive cancers to care for in the United States. Urologists vary widely in how they approach early stage, or non-muscle-invasive, bladder cancer.

In this study, researchers gathered data from the Surveillance, Epidemiology and End Results Medicare database. They looked at 940 doctors who provided care to 20,713 early stage bladder cancer patients. Each doctor included in the study had treated at least 10 patients for bladder cancer.

Results of the study appear in the April 15 issue of the Journal of the National Cancer Institute.

The study found that average per-patient treatment expenditures ranged from $2,830 for doctors in the low-intensity treatment category to $7,131 for doctors in the high-intensity category. At the same time, survival rates across all intensity categories were similar.

"What this indicates is that some doctors are providing potentially unnecessary care, or care without measurable benefit to the patient. It makes sense to many doctors and patients that more would be better, but unfortunately, there can be unintended consequences of unneeded care," says study author Dr. Brent Hollenbeck, assistant professor of urology at the Medical School.

The study found that patients treated more aggressively had more imaging procedures and more invasive surgical procedures. These patients also were nearly twice as likely to require major medical interventions, and were 2.5 times more likely to undergo radical cystectomy, a procedure to remove the bladder.

The study authors suggest that certain patients still might benefit from greater intensity of care, but further research is needed.

The American Cancer Society says 68,810 Americans will be diagnosed with bladder cancer this year and 14,100 will die from the disease.

Other study authors were Zaojun Ye, Rodney L. Dunn, James Montie and John Birkmeyer.