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Can a Centralized, Multidisciplinary Program Improve Outcomes in Muscle-Invasive Bladder Cancer?

By: Emily Rhode
Posted: Monday, December 20, 2021

Sidney Glina, MD, PhD, of the Faculdade de Medicina do ABC, Santo André, Brazil, and colleagues evaluated the impact of a multidisciplinary clinic and centralization-of-care (CABEM) program on mortality rates in patients with muscle-invasive bladder cancer. The data from this retrospective study indicate that a structured multidisciplinary bladder clinic may, in fact, improve outcomes for this patient population. The researchers reported their findings from the study in JCO Global Oncology.

“Programs relying on multidisciplinary clinics, well-established protocols, and the creation of large-volume [bladder cancer] treatment institutions are an effective measure to improve outcomes, reduce mortality, and bring cost-effective treatment for [bladder cancer],” the authors commented.

The medical registry of 116 patients in 2 groups were evaluated. Both groups included patients with muscle-invasive bladder cancer; however, group 1 received treatment between 2011 and 2017, before a bladder cancer program was established, whereas group 2 received treatment after the CABEM program was implemented between 2018 and 2020. A multidisciplinary group of doctors evaluated and treated patients in group 2 after they were referred to the centralized CABEM clinic.

Researchers observed a marked difference in treatment strategies before and after the enactment of the CABEM clinic. All patients in group 1 were treated with radical cystectomy, whereas 53% of patients in group 2 were treated with radical cystectomy. Other treatments given in group 2 included partial cystectomy, trimodal therapies, palliative chemotherapies, and exclusive transurethral resection of the bladder tumor.

Mortality rates were 34.5% versus 5% (P = .0002) for groups 1 and 2, respectively, at 90 days. The 12-month overall survival rate was significantly better for group 2 than group 1 (74% vs. 57%, P = .448). Retrospective calculations of CABEM scores for group 1 indicated the researchers would have chosen a different treatment approach for 51.7% of these patients.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.



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