More may not be better for bladder cancer - study

Tue Apr 7, 2009 4:00pm EDT

*More expensive treatment did not save lives

*Costs ranged from $2,800 to $7,100 per patient

By Maggie Fox, Health and Science Editor

WASHINGTON, April 7 (Reuters) - Patients who get more intensive treatment for early bladder cancer do not fare any better than patients who get less treatment, U.S. researchers reported on Tuesday.

Medicare, the federal health insurance plan for the elderly, spent more than twice as much on the intensively managed patients without improving their survival rates, Dr. Brent Hollenbeck of the University of Michigan and colleagues found.

Their study, published in the Journal of the National Cancer Institute, supports findings that show great variation in how much different hospitals and doctors spend on care, with little indication that spending more helps patients.

"Urologists should not assume that more is necessarily better," Hollenbeck said in a telephone interview.

"We are observing the variation and we are not seeing any benefit with the added treatment. Eliminating unnecessary care is very important. Overuse is a big problem in the U.S. healthcare system."

Bladder cancer affected 68,810 people in 2008 in the United States and killed 14,100, according to the National Cancer Institute. It is more likely to affect men.

Treatment can include surgery, chemotherapy, radiation therapy and infusion of the bacteria used to vaccinate against tuberculosis. Doctors believe the BCG vaccine for TB somehow stimulate immune cells to attack cancer cells.

Hollenbeck and colleagues used federal data on 20,713 Medicare patients diagnosed with early bladder cancer between 1992 and 2002 by 940 different doctors, mostly urologists.

They divided them into four groups based on how much treatment the patients received. Over the time of the study, 7.8 percent of the patients died.

SPENDING DOUBLE

The doctors in the group that gave most care also spent the most -- $7,131 on average. Those who gave the least care billed only $2,830 on average.

"Simply put, urologists who treat aggressively early are likely to provide aggressive treatment in all aspects of bladder cancer care, and vice versa," the researchers wrote.

"More intensive treatment was not associated with better overall survival. Patients who underwent more intensive early treatment were more likely to undergo major interventions later," they added.

They said it did not appear that the patients who got more treatment had more aggressive cancer. However Dr. Gary Lyman of Duke University School of Medicine in North Carolina and colleagues questioned this, saying the medical records may not have given all the details of each case.

"Current clinical practice guidelines on the management of superficial bladder cancer should be followed until more compelling data emerge that confirm that less aggressive treatment and surveillance strategies are safe and effective," they wrote in a commentary.

(Editing by Alan Elsner)