Grand rounds

We were fortunate to have another excellent grand rounds here today. Today was about the state of things for bladder cancer. I'll admit, as an academic oncologist it can be easy to get stuck in your disease-specific silo, so I welcome the chance to hear about controversies or breakthroughs for other cancers. Today, there were a few take-home points for me:

Bladder cancer needs a face, a celebrity or high-profile person who can become an advocate. Say "breast cancer" and we think of Elizabeth Edwards, Christina Applegate and so on. Say "pancreas cancer" and you think of Patrick Swayze and Randy Pausch. Say "lung cancer" and you think of Peter Jennings. Say "bladder cancer" and who comes to mind?
Bladder cancer is the most expensive cancer to treat. I never knew this, but it does make some sense, given the usual low grade of the cancer and the multiple urologic interventions required. The link is to a health economics paper about bladder cancer, which is an area of considerable interest as we seek to trim the health care costs in this country.
Clinical trials in bladder cancer are really hard to accrue to. The presentation today was filled with trials that closed because of poor accrual, and I wonder why. Is it the age of the patients? That most of them are male? Nihilism on the part of the referring physician? Since clinical trials are so hard, a retrospective database review (like SEER) would seem ideal for this disease in particular.