Real-world treatment outcomes in muscle-invasive and metastatic bladder cancer care: Towards better use of outcome data

Abstract

The dissertation describes the outcomes of bladder cancer care in the seven Santeon Hospitals (Canisius Wilhelmina Hospital, Nijmegen; Catharina Hospital, Eindhoven; Maasstad Hospital, Rotterdam; Martini Hospital, Groningen; Medisch Spectrum Twente, Enschede; OLVG, Amsterdam; St. Antonius Hospital, Utrecht/Nieuwegein), collectively responsible for approximately 11% of Dutch hospital care. Before comparing outcomes of bladder cancer care among different patients, treatments, and hospitals in the Netherlands or internationally, standardized data collection methods must first be established. Therefore, a standardized set of outcome measures was developed for this dissertation. This set can be used for precise and uniform data collection, facilitating population-based cohort studies ("real-world studies"). The set was developed by a dedicated team of medical specialists, epidemiologists, registration specialists, nurses, and representatives of patient organizations. As a result, the outcome set reflects what is important to everyone, a step forward in personalized care. Data on nine years of bladder cancer care were collected in the Santeon Hospitals. Our findings demonstrate that the hospital where a patient is treated matters. For example, there is a difference between the use of chemotherapy before bladder removal or in the offering of bladder-sparing treatments. These factors influence patient survival and quality of life. Additionally, outcomes were compared with clinical trials and other "real-world" studies. Our findings show that among bladder cancer patients who are still curable, curative treatments are more frequently used compared to patients in other Western countries. However, chemotherapy is less frequently offered in the palliative setting. When a patient undergoes chemotherapy, they are less likely to complete their course due to adverse events, and they achieve a survival rate of only ±75%, compared to the same patients in clinical trials. Also, our findings show that there seems to be no survival difference in palliative patients treated with cisplatin or carboplatin chemotherapy, even though the latter is regarded as inferior in the medical world. These outcomes provide an opportunity to reflect on current bladder cancer care and will shape the care of tomorrow.