Intensive Bladder Cancer Care May Not Improve Mortality Risk
Study of SEER-Medicare data finds intensive early treatment seldom reduces later interventions
MONDAY, April 13 (HealthDay News) -- Intensive treatment in early-stage bladder cancer does not appear to affect patient survival or avert major interventions later, according to a study published online April 7 in the Journal of the National Cancer Institute.
Brent K. Hollenbeck, M.D., of the University of Michigan Health System in Ann Arbor, and colleagues identified 20,713 patients in the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database who were diagnosed with early-stage bladder cancer from 1992 to 2002. The 940 physicians responsible for providing care were ranked by intensity of treatment delivered to their patients as reflected in Medicare expenditures in the first two years post-diagnosis. The patients were then grouped in quartiles and associations between treatment intensity and outcomes were calculated using Cox proportional hazards models, including all-cause mortality and risk of subsequent interventions.
The authors report that the average Medicare expenditure in the highest quartile of treatment intensity was $7,131, compared with $2,830 in the lowest quartile. Intensive treatment typically included more endoscopic surveillance, more imaging and more intravesical therapy. However, the researchers found that initial treatment intensity was not associated with all-cause mortality risk (hazard ratio, 1.03 for patients receiving low-intensity versus high-intensity care). Further, 11 percent of patients receiving intensive treatment had a major medical intervention compared to 6.4 percent who had less-intensive treatment.
"Providers vary widely in how aggressively they manage early-stage bladder cancer. Patients treated by high-treatment intensity providers do not appear to benefit in terms of survival or in avoidance of subsequent major medical interventions," the authors conclude.