Daan J Reesink1, Ewoudt M W van de Garde2,3, Paul van der Nat4,5, Diederik M Somford6, Maartje Los7, Simon Horenblas8, Harm H E van Melick9. 1. Department of Urology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands. d.reesink@antoniusziekenhuis.nl. 2. Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein / Utrecht, The Netherlands. 3. Division Pharmaco Epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands. 4. Division Value Based Healthcare, St. Antonius Hospital, Nieuwegein / Utrecht, The Netherlands. 5. Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud UMC, Nijmegen, The Netherlands. 6. Department of Urology, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands. 7. Department of Oncology, St. Antonius Hospital, Nieuwegein / Utrecht, The Netherlands. 8. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek (NCI-AVL) Hospital, Amsterdam, The Netherlands. 9. Department of Urology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Abstract
PURPOSE: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. METHODS: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. RESULTS: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74-85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). CONCLUSIONS: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.
PURPOSE: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. METHODS: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. RESULTS: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74-85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). CONCLUSIONS: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.
Authors: Matthew D Galsky; Noah M Hahn; Jonathan Rosenberg; Guru Sonpavde; Thomas Hutson; William K Oh; Robert Dreicer; Nicholas Vogelzang; Cora Sternberg; Dean F Bajorin; Joaquim Bellmunt Journal: Lancet Oncol Date: 2011-03 Impact factor: 41.316
Authors: Marco Moschini; Agostino Mattei; Julian Cornelius; Shahrokh F Shariat; Paolo Dell'Oglio; Emanuele Zaffuto; Andrea Salonia; Francesco Montorsi; Alberto Briganti; Renzo Colombo; Andrea Gallina Journal: World J Urol Date: 2018-01-24 Impact factor: 4.226
Authors: Deborah Schrag; Nandita Mitra; Feng Xu; Farhang Rabbani; Peter B Bach; Harry Herr; Colin B Begg Journal: Urology Date: 2005-06 Impact factor: 2.649
Authors: Hans von der Maase; Lisa Sengelov; James T Roberts; Sergio Ricci; Luigi Dogliotti; T Oliver; Malcolm J Moore; Annamaria Zimmermann; Michael Arning Journal: J Clin Oncol Date: 2005-07-20 Impact factor: 44.544
Authors: H Barton Grossman; Ronald B Natale; Catherine M Tangen; V O Speights; Nicholas J Vogelzang; Donald L Trump; Ralph W deVere White; Michael F Sarosdy; David P Wood; Derek Raghavan; E David Crawford Journal: N Engl J Med Date: 2003-08-28 Impact factor: 91.245
Authors: Ellen van der Vlies; Maartje Los; Pascal E F Stijns; Marike van Hengel; Nynke M S Blaauw; Willem Jan W Bos; Eric P A van Dongen; Harm H E van Melick; Peter G Noordzij Journal: BJU Int Date: 2020-08-04 Impact factor: 5.588
Authors: J Alfred Witjes; Harman Max Bruins; Richard Cathomas; Eva M Compérat; Nigel C Cowan; Georgios Gakis; Virginia Hernández; Estefania Linares Espinós; Anja Lorch; Yann Neuzillet; Mathieu Rouanne; George N Thalmann; Erik Veskimäe; Maria J Ribal; Antoine G van der Heijden Journal: Eur Urol Date: 2020-04-29 Impact factor: 20.096