Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands (2024)

Abstract

Purpose: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. Methods: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. Results: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74–85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). Conclusions: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.

Original languageEnglish
Pages (from-to)1469–1479
Number of pages11
JournalWorld Journal of Urology
Volume40
Issue number6
Early online date10 Apr 2022
DOIs
Publication statusPublished - Jun 2022

Keywords

  • Bladder cancer
  • Metastatic
  • Muscle invasive
  • Outcomes
  • Treatment patterns

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    Santeon MIBC Study Group (2022). Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands. World Journal of Urology, 40(6), 1469–1479. https://doi.org/10.1007/s00345-022-03987-4

    Santeon MIBC Study Group. / Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands. In: World Journal of Urology. 2022 ; Vol. 40, No. 6. pp. 1469–1479.

    @article{2ede24274d9d4a8db28cb6b89403bfbe,

    title = "Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands",

    abstract = "Purpose: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. Methods: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. Results: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74–85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). Conclusions: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.",

    keywords = "Bladder cancer, Metastatic, Muscle invasive, Outcomes, Treatment patterns",

    author = "Reesink, {Daan J} and {van de Garde}, {Ewoudt M W} and {van der Nat}, Paul and Somford, {Diederik M} and Maartje Los and Simon Horenblas and {van Melick}, {Harm H E} and {Santeon MIBC Study Group}",

    note = "Funding Information: This research received a grant from Roche Nederland B.V. to perform this study (Grant number: ML40374). Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank Roche Nederland B.V. for funding for this research project. Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank Roche Nederland B.V. for funding for this research project. The Santeon MIBC Study Group (collaborators) are: D.H. Biesma, P.E.F. Stijns, J. Lavalaye, P.C. De Bruin, B.J.M. Peters, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands; M. Berends, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands; R. Richardson, Catharina Hospital, Eindhoven, The Netherlands; J. Van Andel, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands; O.S. Klaver, B.C.M. Haberkorn, Maasstad Hospital, Rotterdam, The Netherlands; J.M. Van Rooijen, Martini Hospital, Groningen, The Netherlands; R.A. Korthorst, Medisch Spectrum Twente (MST), Enschede, The Netherlands; R.P. Meijer, J.R.N. Van der Voort Van Zyp, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

    year = "2022",

    month = jun,

    doi = "10.1007/s00345-022-03987-4",

    language = "English",

    volume = "40",

    pages = "1469–1479",

    journal = "World Journal of Urology",

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    publisher = "Springer",

    number = "6",

    }

    Santeon MIBC Study Group 2022, 'Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands', World Journal of Urology, vol. 40, no. 6, pp. 1469–1479. https://doi.org/10.1007/s00345-022-03987-4

    Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands. / Santeon MIBC Study Group.
    In: World Journal of Urology, Vol. 40, No. 6, 06.2022, p. 1469–1479.

    Research output: Contribution to journalArticleAcademicpeer-review

    TY - JOUR

    T1 - Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands

    AU - Reesink, Daan J

    AU - van de Garde, Ewoudt M W

    AU - van der Nat, Paul

    AU - Somford, Diederik M

    AU - Los, Maartje

    AU - Horenblas, Simon

    AU - van Melick, Harm H E

    AU - Santeon MIBC Study Group

    N1 - Funding Information:This research received a grant from Roche Nederland B.V. to perform this study (Grant number: ML40374).Funding Information:The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank Roche Nederland B.V. for funding for this research project.Funding Information:The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank Roche Nederland B.V. for funding for this research project. The Santeon MIBC Study Group (collaborators) are: D.H. Biesma, P.E.F. Stijns, J. Lavalaye, P.C. De Bruin, B.J.M. Peters, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands; M. Berends, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands; R. Richardson, Catharina Hospital, Eindhoven, The Netherlands; J. Van Andel, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands; O.S. Klaver, B.C.M. Haberkorn, Maasstad Hospital, Rotterdam, The Netherlands; J.M. Van Rooijen, Martini Hospital, Groningen, The Netherlands; R.A. Korthorst, Medisch Spectrum Twente (MST), Enschede, The Netherlands; R.P. Meijer, J.R.N. Van der Voort Van Zyp, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.Publisher Copyright:© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

    PY - 2022/6

    Y1 - 2022/6

    N2 - Purpose: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. Methods: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. Results: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74–85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). Conclusions: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.

    AB - Purpose: Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands. Methods: Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1. Results: The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74–85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001). Conclusions: There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.

    KW - Bladder cancer

    KW - Metastatic

    KW - Muscle invasive

    KW - Outcomes

    KW - Treatment patterns

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    U2 - 10.1007/s00345-022-03987-4

    DO - 10.1007/s00345-022-03987-4

    M3 - Article

    C2 - 35397692

    SN - 0724-4983

    VL - 40

    SP - 1469

    EP - 1479

    JO - World Journal of Urology

    JF - World Journal of Urology

    IS - 6

    ER -

    Santeon MIBC Study Group. Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands. World Journal of Urology. 2022 Jun;40(6):1469–1479. Epub 2022 Apr 10. doi: 10.1007/s00345-022-03987-4

    Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands (2024)

    FAQs

    What is the latest treatment for muscle-invasive bladder cancer? ›

    In 2023, the Food and Drug Administration (FDA) approved a two-drug combination of enfortumab vedotin and pembrolizumab (EV/pembro) to treat locally advanced or metastatic urothelial bladder cancer.

    How long can you live with muscle-invasive bladder cancer? ›

    Five-year survival rates are 75% to 100% for grade 1 tumors, 46% to 75% for grade 2, and 22% to 55% for grade 3.

    What is the treatment of choice for muscle-invasive bladder cancer? ›

    Systemic chemotherapy

    Chemotherapy uses drugs to kill or slow the growth of cancer cells. For muscle-invasive bladder cancer, drugs are injected into a vein (intravenously). As the drugs circulate in the blood, they travel throughout the body. This type of chemotherapy is called systemic chemotherapy.

    What is the best treatment for metastatic bladder cancer? ›

    Targeted therapy is sometimes used to treat metastic bladder cancer. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells.

    How quickly does muscle invasive bladder cancer spread? ›

    “If the cancer invades the bladder, it can spread to the lymph nodes within months,” Dr. Linehan said. However, if the cancer is in situ (on the surface of the bladder), it can take years to spread.

    What is the gold standard for muscle invasive bladder cancer? ›

    Over the past 15 years, several randomized controlled trials have reinforced pre-surgery chemotherapy as a first step to shrink tumors followed by surgery as the gold standard treatment for muscle-invasive bladder cancer.

    Is muscle invasive bladder cancer aggressive? ›

    Most patients with muscle-invasive bladder cancer are elderly or have multiple comorbidities. In the U.S., more than 25% of them don't receive any definitive treatment. This is an aggressive cancer for patients who are considered too frail for standard treatments, including radical surgery.

    What stage of bladder cancer is muscle invasive? ›

    Stage II may also be described as muscle-invasive bladder cancer. In stage II, cancer has spread through the connective tissue into the muscle layers of the bladder. Stage II bladder cancer (muscle-invasive bladder cancer). Cancer has spread through the connective tissue into the muscle layers of the bladder.

    What is the prognosis of patients with muscle invasive bladder cancer who are intolerable to receive any anti cancer treatment? ›

    Thus, the no anti-cancer treatment group clearly had a worse prognosis than the RC group (p<0.001). Of the 26 untreated patients, 20 died. Of these, 17 died of bladder cancer and 3 died from other causes (one thyroid cancer,one asphyxiation, one pneumonia). Cancer specific survival was 12 months (95% CI, 7–16 months).

    What is the non surgical treatment for muscle invasive bladder cancer? ›

    Chemotherapy. Sometimes, chemotherapy is used during treatment for muscle-invasive bladder cancer. Instead of medicine being put directly into your bladder, it's put into a vein in your arm.

    What is the standard of care for muscle invasive bladder cancer? ›

    Treatments for Muscle-Invasive (Advanced) Bladder Cancer

    When bladder cancer tumors completely invade the bladder's muscular wall, the standard of care is to perform bladder removal surgery. Typically, complete removal of the bladder (radical cystectomy) is required.

    What is the first line treatment for muscle invasive bladder cancer? ›

    If you have an invasive carcinoma, such as a muscle-invasive cancer, we generally treat that with upfront cisplatin-based combination chemotherapy, followed by removal of the bladder or radiation.

    What causes death in metastatic bladder cancer? ›

    Approximately 80% of patients living with metastatic cancer will die of their diagnosed cancer, while 20% will die of competing causes (heart disease, COPD, stroke, subsequent cancer deaths in >50% of these patients). This has remained consistent for 30 years.

    Where is the first place bladder cancer spreads? ›

    Where can bladder cancer spread to? Not all bladder cancers will spread. But If it does it's most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagin*, or into the pelvis. This is called local spread.

    What is the new cancer treatment for bladder cancer? ›

    UPDATE: On December 15, 2023, FDA approved enfortumab vedotin (Padcev) in combination with pembrolizumab (Keytruda) for people with bladder cancer that has spread to other parts of the body or cannot be removed surgically.

    What are the treatment guidelines for muscle invasive bladder cancer? ›

    Recommendations. Multidisciplinary care for patients with MIBC and metastatic bladder cancer is critical. The standard treatment of MIBC (cT2-T4a N0M0) is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy. In cisplatin-ineligible patients, radical cystectomy alone is recommended.

    How is high grade muscle invasive urothelial carcinoma treated? ›

    If you have an invasive carcinoma, such as a muscle-invasive cancer, we generally treat that with upfront cisplatin-based combination chemotherapy, followed by removal of the bladder or radiation.

    What happens if bladder cancer is in the muscle? ›

    If the bladder cancer has invaded the muscle of the bladder wall, then there is a very high risk that the patient will die of bladder cancer unless radical treatment with either radical cystectomy or radical radiotherapy is done.

    What stage is muscle invasive bladder cancer? ›

    Stage II may also be described as muscle-invasive bladder cancer. In stage II, cancer has spread through the connective tissue into the muscle layers of the bladder. Stage II bladder cancer (muscle-invasive bladder cancer). Cancer has spread through the connective tissue into the muscle layers of the bladder.

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