Contemplating bladder cancer care: Can we cut costs and improve quality of care?

摘要

Amid the increased focus on cost–effectiveness brought upon us by the recently signed Patient Protection and Affordable Care Act and the emergence of the economic crisis in Europe, an article published in this issue of Expert Review of Anticancer Therapy addresses the pharmacoeconomic aspects of the most expensive cancer per capita in the USA – bladder cancer [1]. Bladder cancer is a heterogeneous disease that includes indolent urothelial neoplasms confined within the lamina propria of the bladder mucosa, as well as muscle-infiltrating cancers with high risk of spreading to other organs. Although the former and the latter cancer originate from a urothelial cell, their potential for growth and their ability to spread differ profoundly, and consequently there are important differences related to their management and follow-up. A small, low-grade cancer without concurrent carcinoma in situ confined to the urothelium of the bladder mucosa should be managed by a transurethral resection followed by intravesical chemotherapy and monitored by cystoscopy after 3 and 6 months, and thereafter annually for 5 years [2]. On the other hand, patients suffering from bladder cancer infiltrating the muscle layer should be scheduled for radical cystectomy. Radical cystectomy involves the complete extirpation of the bladder with subsequent deviation of the urine through a cystostoma and typically includes removal of the prostate in men, and the uterus, ovaries and anterior vaginal wall in women. The procedure has a severe impact on urinary function, sexual function, body image and mental health. However, once bladder cancer has infiltrated the underlying muscle, it represents the only treatment option that can offer a cancer-free survival, provided the cancer has not spread outside of the bladder.