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Risk does not dictate real-world surveillance frequency for bladder cancer

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September 28, 2018

Patients with high-risk early-stage bladder cancer underwent surveillance about as frequently as low-risk patients, according a retrospective study of veterans.

“Guidelines for cancer surveillance routinely recommend aligning care with patients’ underlying cancer risk,” Florian R. Schroeck, MD, MS, section chief of urology at White River Junction Veterans Affairs Medical Center and assistant professor of surgery (urology) at Dartmouth Hitchcock Medical Center, and colleagues wrote. “Risk-aligned surveillance is likely to become even more relevant in the future, as the advent of personalized medicine increases the possibilities to predict each patient’s cancer risk.”

Schroeck and colleagues examined surveillance patterns among patients diagnosed with low- or high-risk early stage bladder cancer between 2005 and 2011 and treated across 85 U.S. Department of Veterans Affairs facilities, with follow-up through 2014.

The analysis included 1,278 low-risk patients and 2,115 high-risk patients (median age, 77 years; 99% men); 36.5% were aged 80 years or older and 19.8% had more than three comorbidities.

Researchers used European Association of Urology risk-stratification guidelines to identify low- and high-risk patients.

The adjusted mean frequency of surveillance cystoscopy was 4.8 procedures (range, 3.7-6.2) per 2 years among low-risk patients, compared with 5.4 procedures (range, 4.6-6) among high-risk patients.

In 70 of the 85 VA facilities, researchers found surveillance frequency was comparable among the risk groups, differing by less than one cystoscopy over 2 years.

Surveillance frequency among high-risk groups was significantly higher statistically at only four facilities.

Across all facilities, researchers found a moderately strong correlation of surveillance frequency for low-risk vs. high-risk patients (r = 0.52; P < .001).

“This is the first study, to our knowledge, to examine whether risk-aligned cancer surveillance is performed in a national health system,” the researchers wrote. “As one of many cancers for which ongoing surveillance is routinely recommended, early-stage bladder cancer serves as a useful paradigm for assessing surveillance practices because of its high prevalence and because surveillance with cystoscopy is identifiable using administrative data.”

The limitations of the study included the use of VA data, limited data from individual facilities and difficulty ascertaining cancer risk.

“Our findings should alert those who care for patients with bladder cancer and those who care for patients with other neoplasms for which risk-aligned surveillance is recommended,” the researchers wrote. “While risk factors, natural history and tumor-specific characteristics differ across neoplasms, the challenges clinicians face to align surveillance with underlying cancer risk are likely similar.” – by Cassie Homer

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Disclosures: Schroeck reports a principal investigator role for a trial sponsored by Eleven Biotherapeutics. One author reports stock ownership in Johnson & Johnson.

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