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Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM
Fernando Korkes1,2, Frederico Timóteo1,2, Suelen Martins3
1Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.
JCO Global Oncology
|November 12, 2021
Summary
Implementing a bladder cancer centralization program significantly reduced mortality for muscle-invasive bladder cancer (MIBC) patients in Brazil. This multidisciplinary approach improved treatment outcomes and survival rates.
Area of Science:
- Urology
- Oncology
- Public Health
Background:
- Muscle-invasive bladder cancer (MIBC) presents a significant treatment challenge, particularly in developing nations where data is limited and mortality rates appear high.
- Existing healthcare models may not adequately address the complexities of MIBC treatment, leading to suboptimal patient outcomes.
Purpose of the Study:
- To evaluate the impact of a multidisciplinary clinic and a care centralization program (CABEM program) on the treatment and outcomes of MIBC in Brazil.
- To assess whether a structured, centralized approach improves survival and treatment modalities for MIBC patients.
Main Methods:
- Retrospective evaluation of 116 consecutive MIBC patients, divided into two groups: 58 treated before (2011-2017) and 58 after the CABEM program implementation.
- Comparison of patient demographics, comorbidity indexes, treatment types, perioperative outcomes, and mortality rates between the two groups.
Main Results:
- Patients in the CABEM program group were older, had higher BMI, and more comorbidities compared to the pre-program group.
- The CABEM program facilitated a wider range of treatments, including neoadjuvant chemotherapy for radical cystectomy patients, unlike the pre-program group.
- Ninety-day mortality significantly decreased from 34.5% to 5% (P < .002) in the CABEM program group, with lower one-year mortality also observed.
Conclusions:
- A centralization program, incorporating a structured bladder clinic, multidisciplinary team, and standardized protocols, demonstrably improves outcomes for MIBC patients.
- The integration of chemotherapy and radiotherapy within a centralized care model is crucial for enhancing treatment efficacy and survival in MIBC.
- This study provides evidence for the effectiveness of centralized, multidisciplinary care in managing aggressive cancers like MIBC in resource-limited settings.
