Physicians Ignoring Care Guidelines?

Bladder cancer patients don't get recommended treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Recommended guidelines for care exist for nearly every disease and condition. But for one form of cancer -- bladder -- 99 percent of patients are not receiving recommended care.

Nearly all high-grade noninvasive bladder cancer patients do not receive the complete care recommended by current guidelines, according to recent research. A study indicates that efforts are needed to find out why official suggestions are being ignored.

"Ask your doctor about bladder cancer care therapies."

High-grade noninvasive bladder cancer is not something that should be treated lightly. There's up to a 70 percent chance of this cancer recurring after treatment. What's more, this form of cancer progresses to a more invasive tumor in 50 percent of cases.

Medical treatment guidelines recommend intravesical therapy, in which chemotherapy medications are delivered directly into the bladder. This regimen is recommended for avoiding recurrence and preventing disease progression. Intense follow-up treatment is also recommended, involving bladder and urine tests every three months.

Multiple surgeries are required to treat recurring non-invasive bladder tumors. If the tumor returns and becomes an invasive cancer, it can become metastatic, meaning the cancer spreads beyond the orginal site.

When this happens, the bladder may need to be surgically removed, increasing the risk for radiation and chemotherapy treatments.

Karim Chamie, M.D., of the University of California Los Angeles led a team of researchers from UCLA's Jonsson Comprehensive Cancer Center to investigate if patients were receiving the proper level of care. They analyzed data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Participants included 4,545 patients diagnosed with high-grade noninvasive bladder cancer from 1992 to 2002.

Surprisingly, researchers found that only one patient received the recommended care. Nearly half of urologists had not performed the recommended tests or treatment for this disease in the first two years after diagnosis, according to Dr. Chamie.

The team found that patient factors -- age, race, socioeconomic status, other medical conditions and severity of the cancer -- had little impact on compliance. Instead, the physician was the most important predictor of the level of care received.

Dr. Chamie said these findings shed light on this issue and should prompt review of reimbursement policies and quality-improvement initiatives.

The study was published in CANCER, a peer-reviewed journal of the American Cancer Society.

Reviewed by: 
Review Date: 
July 11, 2011
Last Updated:
July 12, 2011