Because bladder cancer is often treated as a chronic disease requiring lifelong surveillance, it is among the most expensive cancers to treat in
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
The study found that average per-patient treatment expenditures ranged from
"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
The study found that patients treated more aggressively had more imaging procedures and more invasive surgical procedures. The aggressively treated patients were also 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 might still benefit from greater intensity of care, but further research is needed to determine which patients would benefit. Hollenbeck also urges randomized clinical trials to look at the value of some of the more expensive and common health services to determine their optimal use for patients with early stage bladder cancer.
"Urologists should not assume that more aggressive management of early stage bladder cancer will translate into better outcomes for their patients. By reducing unnecessary health care, we can reduce wasteful spending, which will lessen the cost burden of bladder cancer, one of the most expensive cancers to treat from diagnosis to death," Hollenbeck says.
Bladder cancer statistics: 68,810 Americans will be diagnosed with bladder cancer this year and 14,100 will die from the disease, according to the American Cancer Society
Additional authors: Zaojun Ye,
Funding: American Cancer Society, American Urological Association Foundation, Astellas Pharma, National Cancer Institute
Reference: Journal of the National Cancer Institute, Vol. 101, Issue 8, pp. 571-580
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