In a recently published study in Cancer, researchers at UCLA’s Jonsson Comprehensive Cancer Center found that just one in 4,545 people with high-grade noninvasive bladder cancer was treated according to the comprehensive care guidelines set by the American Urological Association and the National Comprehensive Cancer Network.
The cells in a patient with high-grade cancer show greater abnormality than cells in a patient with a low-grade tumor. Guidelines for high-grade cancer require an initial injection of chemotherapy drugs directly into the bladder to kill cancer cells and an intense follow-up surveillance schedule that involves using a scope to assess the bladder (cystoscopy) and urine testing (cytology) four times a year. This chemotherapy shot should be followed by a six-week course of Bacillus Calmette-Guerin (BCG) treatment, which creates an inflammatory response, causing the body to attack the cancer. Also recommended is imaging of the upper urinary tract with a CT scan, MRI scan, or renal ultrasound at diagnosis and every two years.
Researchers found that compliance with these guidelines had more to do with the doctors treating the patients than with the patients’ age, race, or economic status. They concluded that the guidelines my not be reaching urologists at community hospitals, which is where the majority of patients receive treatment.
The authors’ suggestions for increasing compliance rates included modifying reimbursement rates and conducting more research to identify factors inhibiting comprehensive treatment. Karim Chamie, M.D., a postdoctoral fellow in urologic oncology and health services and the lead author of the study, believes that meeting the recommended guidelines for high-grade bladder cancer patients will significantly reduce the mortality rate.