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Understanding bladder cancer death: tumor biology versus physician practice
David S Morris1, Alon Z Weizer, Zaojun Ye
1Department of Urology, Taubman Health Care Center, Room 3875, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
Background:
To the authors' knowledge, the extent to which death from bladder cancer is attributable to tumor biology or physician practice patterns is unknown. For this reason, the relative importance of broadening indications for aggressive therapy has unclear implications.
Methods:
Patients whose deaths were caused directly by bladder cancer were identified using institutional (n = 126 patients) and administrative (n = 6326 patients) data sources. By using implicit review (clinical data, 2001-2005) and explicit algorithms (Surveillance, Epidemiology, and End Results [SEER]-Medicare, 1992-2002), the authors estimated the proportion of potentially avoidable deaths from bladder cancer.
Results:
After an implicit review of clinical data, 40 of 126 deaths (31.7%) were classified as potentially avoidable. Compared with those patients who were deemed unsalvageable, these patients generally presented with nonmuscle-invasive disease (80% vs 25.6%; P < .001), received multiple courses of intravesical therapy (32.5% vs 1.2%; P < .001), and had a more protracted course from diagnosis to aggressive treatment (median, 23 months vs 2 months; P < .001). An explicit review of claims data indicated that between 31.6% and 46.8% of the 6326 bladder cancer deaths identified in the SEER-Medicare data potentially were avoidable, depending on the survivorship threshold chosen. Patients whose deaths potentially were avoidable more commonly presented with nonmuscle-invasive disease (66.7% vs 24.7%; P < .0001) and lower grade disease (35.1% vs 15.1%; P < .0001).
Conclusions:
The greatest inroads into reducing death from bladder cancer likely hinge on earlier detection or improvement of systemic therapies. However, changing physician practice may translate into nontrivial reductions in bladder cancer mortality.
Insights
A significant portion of bladder cancer deaths may be preventable. Improving early detection and physician practices could reduce bladder cancer mortality rates.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- The proportion of bladder cancer deaths attributable to tumor biology versus physician practice patterns remains unknown.
- Implications for broadening aggressive therapy indications are unclear.
Purpose of the Study:
- To estimate the proportion of potentially avoidable bladder cancer deaths.
- To investigate the role of physician practice patterns in bladder cancer mortality.
Main Methods:
- Identified bladder cancer deaths using institutional (126 patients) and administrative (6326 patients) data.
- Employed implicit review of clinical data (2001-2005) and explicit algorithms (SEER-Medicare, 1992-2002) to assess avoidability.
Main Results:
- Implicit review found 31.7% of deaths potentially avoidable, often associated with nonmuscle-invasive disease and delayed treatment.
- Explicit review suggested 31.6%-46.8% of deaths were potentially avoidable, linked to nonmuscle-invasive and lower-grade disease.
- Avoidable deaths frequently involved patients with nonmuscle-invasive disease and those receiving multiple intravesical therapies.
Conclusions:
- Reducing bladder cancer mortality may be achieved through earlier detection or improved systemic therapies.
- Modifications in physician practice patterns could lead to substantial reductions in bladder cancer deaths.
