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Aggressive treatment did not improve survival in early-stage bladder cancer
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Within the first two years of diagnosis, intense treatment of early-stage bladder cancer did not improve survival or prevent additional major medical interventions, according to data from an analysis of SEER-Medicare data. Conversely, patients who received less intensive treatment had a 30% lower risk for death.
Researchers identified 20,713 patients diagnosed with early-stage bladder cancer between January 1992 and December 2002 who were treated by 940 physicians. The researchers ranked the physicians according to the intensity of the treatment they provided, which was determined using Medicare expenditures for early-stage bladder cancer that were reported during the first two years after diagnosis.
Provider treatment intensity was categorized as quartiles of patients. Among quartiles, Medicare expenditures for original disease management varied by more than twofold. According to the researchers, costs ranged from a mean $2,830 per-patient for low-treatment intensity to $7,131 for high-treatment intensity providers.
Additionally, median survival ranged from 76.5 months for the second highest quartile to 79.8 months for the second lowest quartile (P=.50). Between January 1992 and December 2005, 55.4% of patients died from any cause; the risk for death from any cause was similar between the low-treatment intensity and high-treatment intensity groups (HR=1.03; 95% CI, 0.97-1.09). However, the risk for death from bladder cancer was 30% lower among patients treated by low-treatment intensity providers compared with high-treatment intensity providers (HR=0.70; 95% CI, 0.59-0.83).
Patients treated by high intensity providers were not spared additional major medical interventions compared with patients treated by low intensity providers (11.0% vs. 6.4%; P=.02). Patients treated by high intensity providers were more likely to undergo radical cystectomy compared with patients treated by low intensity providers (3.9% vs. 1.6%; P<.001).
“The apparent association between provider treatment intensity defined as greater average bladder cancer expenditures and worse bladder cancer-specific but not overall survival is more likely the result of cofounding by unavailable prognostic factors than the result of adverse events resulting from the procedures themselves,” Gary H. Lyman, MD, MPH, FRCP, division of medical oncology, Duke University School of Medicine, Nicole M. Kuderer, MD, hematology/oncology fellow, Duke Comprehensive Cancer Center and Stephen J. Freedland, MD, division of urology, Duke University School of Medicine, wrote in an accompanying editorial.
According to the editorial authors, results from analyses of health care claims should be read with caution due to potential missing clinical data that may explain treatment decisions.
Hollenbeck BK. J Natl Cancer Inst. 2009;101:571-580.