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Bladder Cancer: Narrowing the Gap Between Evidence and Practice

Year: 2009

Type: editorial

Abstract: The American Cancer Society estimates that bladder cancer (BC) accounted for more than 14,000 deaths in 2008. At only 14 months, the median survival for patients with metastatic BC has not significantly changed during the last two decades. No new agents have been approved for BC treatment for more than a decade, few new therapies are being tested in this area, and research in BC has historically been underfunded. In addition, several therapeutic interventions known to influence survival have not been widely adopted into practice. Cystectomy is often delayed in patients with high-risk non–muscle-invasive BC. In muscle-invasive disease, mounting evidence supports the importance of a more extensive surgical approach and the beneficial role of neoadjuvant chemotherapy on survival; however, a wide gap remains between evidence and practice. Even in academic centers, only a few patients with muscle-invasive disease undergo a more extended lymph node dissection and receive neoadjuvant chemotherapy. A recent study1 evaluating the integration of chemotherapy for BC in the United States using the National Cancer Database revealed that only 11.6% of patients received any perioperative chemotherapy, most of those in the adjuvant setting. Given these challenges, two imperatives are before us: (1) improving patient outcomes by defining and implementing optimal standards of care, and (2) identifying and prioritizing specific strategies to advance development of more effective therapies for patients with BC.

Source: Journal of Clinical Oncology

DOI: 10.1200/jco.2009.23.6901