Hospital variation in treatment patterns and oncological outcomes for patients with muscle-invasive and metastatic bladder cancer in the Netherlands
Reesink, Daan J.; van de Garde, Ewoudt M.W.; van der Nat, Paul; Somford, Diederik M.; Los, Maartje; Horenblas, Simon; van Melick, Harm H.E.; Biesma, D. H.; Stijns, P. E.F.; Lavalaye, J.; De Bruin, P. C.; Peters, B. J.M.; Berends, M.; Richardson, R.; Van Andel, J.; Klaver, O. S.; Haberkorn, B. C.M.; Van Rooijen, J. M.; Korthorst, R. A.; Meijer, R. P.; Van der Voort Van Zyp, J. R.N.; for the Santeon MIBC Study Group
(2022) World Journal of Urology, volume 40, issue 6, pp. 1469 - 1479
(Article)
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
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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.
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Keywords: Bladder cancer, Metastatic, Muscle invasive, Outcomes, Treatment patterns, Urology
ISSN: 0724-4983
Publisher: Springer Verlag
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: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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