For invasive bladder cancer, removing whole bladder better than less invasive options

A large nationwide study led by The University of Texas Medical Branch at Galveston has confirmed that for patients with bladder cancer, removing the whole organ increases their chances of survival and is more cost-effective than therapies that selectively target and remove cancerous tissue from the bladder.

There were an estimated 79,000 new cases and 17,000 deaths from bladder cancer in the U.S. in 2017. The current guidelinerecommended treatment for bladder cancer is for patients to have their bladder and surrounding lymph nodes removed surgically in addition to undergoing chemotherapy. This surgery is complex and because bladder cancer patients are often older, many of them have health issues beyond the bladder cancer. For this reason, in addition to health-related quality of life concerns, both health professionals and patients have sought out other treatment strategies.

An increasing number of people are opting for a less invasive treatment strategy that doesn’t involve removing the whole bladder. With this approach, the surgeon takes small samples of bladder tissue to locate cancerous sections and removes only the cancerous tissue. These patients also receive chemotherapy and radiotherapy.

“In this study, our analysis of data from 3,200 Medicare beneficiaries diagnosed with clinical stage II through IV bladder cancer found that removing the whole bladder at once improved survival rates,” said Stephen B. Williams, M.D., lead author and associate professor in the UTMB department of surgery, division of urology. “We also summed up all Medicare healthcare expenditures from inpatient, outpatient and physician services within 30, 90 and 180 days of both treatment approaches, finding the complete bladder removal to be more cost effective.”

The researchers found that at the U.S. national level, the less invasive therapy ended up costing $335 million more in one year when compared with complete bladder removal.

“These findings provide important insight on how to provide cancer care that is both appropriate and cost-effective treatment for patients who are candidates for either treatment,” said Williams.