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Article first published online: 22 MAR 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 11, pages 2604–2611, 1 June 2010
How to Cite
Strope, S. A., Ye, Z., Hollingsworth, J. M. and Hollenbeck, B. K. (2010), Patterns of care for early stage bladder cancer. Cancer, 116: 2604–2611. doi: 10.1002/cncr.25007
Dr. Strope's work was supported by National Institutes of Health (T32 DK007782-08). Dr. Hollenbeck's work was supported by the American Cancer Society Pennsylvania Division—Dr. William and Rita Conrady Mentored Research Scholar Grant (MSRG-07-006-01-CPHPS); American Urological Association Foundation; Astellas Pharma US, Inc.
See editorial on pages 2508-10, in this issue.
- Issue published online: 19 MAY 2010
- Article first published online: 22 MAR 2010
- Manuscript Accepted: 12 AUG 2009
- Manuscript Revised: 7 AUG 2009
- Manuscript Received: 25 JUN 2009
- National Institutes of Health. Grant Number: T32 DK007782-08
- American Cancer Society Pennsylvania Division. Grant Number: MSRG-07-006-01-CPHPS
- American Urological Association Foundation
- Astellas Pharma US, Inc.
- urinary bladder neoplasms;
- health expenditures;
- cost savings;
- guideline adherence
Early stage bladder cancer is a heterogeneous disease with a variable risk of progression and mortality. Uncertainty surrounding the optimal care for these patients may result in a mismatch between disease risk and treatment intensity.
Using Surveillance, Epidemiology, End Results-Medicare data, we identified patients diagnosed with early stage bladder cancer (n = 24,980) between 1993 and 2002. We measured patients' treatment intensity by totaling all Medicare payments made for bladder cancer in the 2 years after diagnosis. Using multiple logistic regression, we assessed relationships between clinical characteristics and treatment intensity. Finally, we determined the extent to which a patient's disease risk matched with their treatment intensity.
The average per capita expenditures increased from $6,936 to $7,642 over the study period (10.2% increase; P < .01). This increase was driven by greater use of intravesical therapy (2.6 vs 3.7 instillations per capita, P < .01) and physician office visits (3.0 vs 4.8 visits per capita, P < .01). Generally, treatment intensity was appropriately aligned with many clinical characteristics, including age, comorbidity, tumor stage, and grade. However, treatment intensity matched disease risk for only 55% and 49% of the lowest and highest risk patients, respectively.
The initial treatment intensity of early stage bladder cancer is increasing, primarily through greater use of intravesical therapy and office visits. Treatment intensity matches disease risk for many, but up to 1 in 5 patients may receive too much or too little care, suggesting opportunities for improvement. Cancer 2010. © 2010 American Cancer Society.