What Drives Bladder Cancer Surveillance Non-Compliance?
The American Urological Association recommends patients who have had a bladder tumor removed undergo bladder cancer surveillance every three to six months for three years and at least annually after that. However, only 40 percent of patients comply with bladder cancer surveillance guidelines.
Although many efforts in the detection and treatment of bladder cancer have resulted in improved mortality and morbidity outcomes, this isn't necessarily the case when it comes to bladder cancer. Even though the Bladder Cancer Advocacy Network (BCAN) and other advocacy groups have improved patient awareness, and AUA and NCCN have created well defined diagnosis and treatment guidelines, the five-year bladder cancer survival rates have stayed level since the 1990s. There could be several reasons for this, but continued poor compliance with the set guidelines is one major cause. And, various studies have shown compliance remains low despite increased patient awareness and well-established guidelines.
Why Bladder Cancer Surveillance Is Important
Bladder cancer surveillance is essential for many reasons, including:
1. The Number of Bladder Cancers Continues to Increase
Annually, over 80,000 individuals in the U.S. receive a bladder cancer diagnosis, and this number continues to rise.
Bladder cancer is the fourth top form of cancer in men, and the 5th most common overall. Most individuals who develop bladder cancer are over the age of 55, and the risk increases with age. The most substantial and common risk factor for this cancer is smoking. Those who smoke are three times more likely to develop bladder cancer than nonsmokers. According to the American Cancer Society, smoking causes over half of all bladder cancer cases.
Other risk factors linked with increased risk of bladder cancer include:
- Workplace chemical exposure, including those used in printing, machining, hairdressing, truck driving and the textile industry
- Chronic bladder infections and irritations
- Bladder birth defects
- Cancer in any area of the lining of your urinary tract
- Genetic mutations for this type of cancer
- Drinking well water that has increased arsenic content
- Not drinking enough fluids
- Certain medicines like the long-term chemotherapy medication cyclophosphamide
- Radiation therapy
You can help reduce the risk of bladder cancer with certain lifestyle changes like eating plenty of vegetables and fruits, quitting smoking and lowering the fat content in your diet.
2. High Recurrence Rate
Depending on the grade and stage, bladder cancer has a 50 to 90 percent recurrence rate.
Being the fifth most common type of cancer in the U.S., bladder cancer also has the highest recurrence risk of all cancers. However, while bladder cancer does have the highest recurrence rate, around 75 percent of all cancer detections are in the early stages and very treatable.
Almost three-quarters of patients suffering from high-grade, non-muscle-invasive bladder cancer had the disease return within 10 years. Of these patients, 33 percent had their cancer progress to a more advanced form which required systemic chemotherapy, radiation therapy, or the removal of their bladder. Of those patients with a recurrence, 41 percent had their cancer return without further spread of the cancer to other parts of their body.
Researchers at the Jonsson Comprehensive Cancer Center at UCLA found more extreme treatment and surveillance of bladder cancer during the first couple of years after diagnosis could decrease the recurrence rate following treatment as well as lower the death rate of the disease.
3. Increased Risk of Second Cancers
While you can have some health issues affect you after surviving cancer, frequently a big concern is having to face cancer again. When the same cancer returns after treatment, it's a recurrence, but there's also the risk you can develop a new, unrelated type of cancer later known as second cancer.
Just because you receive treatment for bladder cancer, this doesn't mean you don't have the possibility of getting another cancer. Being a survivor of bladder cancer, you can still develop any type of second cancer, and you have an increased risk of this compared to the general population.
Examples of second cancer are:
- Pancreatic cancer
- Esophageal cancer
- Kidney cancer
- Larynx (voice box) cancer
- Prostate cancer
- Vaginal cancer
- Lung cancer
- Acute myeloid leukemia (AML)
- Skin cancer, excluding squamous and basal cell skin cancers
Many of these cancers are associated with smoking.
If you've undergone radical cystectomy, you'll still need routine surveillance so your doctor can monitor for local recurrence or metastatic disease development. You should have a pelvic and abdominal CT scan, as well as chest radiography, performed once a year. If at the time of the cystectomy, you have more adverse pathology, such as lymph node metastases or locally advanced disease, you might require imaging more often.
4. Survival Rates and Risk of Death
If your cancer spreads through your bladder to nearby organs, lymph nodes or surrounding tissue, you have a 35 percent five-year survival rate. Your five-year survival rate is decreased to five percent if the cancer has spread to distant parts of your body.
When compared to cervical cancer where screening is widely practiced, bladder cancer is much more common with over 80,000 cases versus over 10,000. It also has a higher mortality rate than does cervical cancer (over 18,000 deaths versus over 3,500) in the U.S.
5. Bladder Cancer Is Very Treatable With Early Detection
Many factors determine survival rates, including the stage and type of bladder cancer you have. If your bladder cancer hasn't spread past the inner layer of your bladder wall, your five-year survival rate is 95 percent. Around half of patients are at this stage when diagnosed.
6. Little Progress in Improving Patient Survival With Advanced Bladder Cancer
This is why early detection is so important. Long-term follow up has shown results which suggest a noticeable decrease in mortality when bladder cancer is diagnosed in the early stages.
7. Bladder Cancer Is the Most Expensive Cancer to Treat in the U.S.
Studies show bladder cancer screening may not just save lives, but also decrease costs per year-life saved.
Like with any cancer, bladder cancer can have an extremely substantial financial impact on individuals. Many who receive a bladder cancer diagnosis concern themselves with the costs associated with bladder cancer and the necessary treatment. The overall expenses of treatment and care can vary widely for individuals due to the duration and type of required treatment.
Some types of costs could include:
- Laboratory tests
- Healthcare provider visits
- Treatments like radiation therapy
- Medicines like chemotherapy for treating bladder cancer
- Medicines to manage or reduce symptoms and side effects
- Costs of clinical trial participation
A study using a Markov model for estimating the efficacy of screening compared to no screening and cumulative cancer-related cost showed in a high-risk population, urine-based markers are most cost-effective. According to the study, bladder cancer screening in a population with a 4 percent bladder cancer incidence led to an increase of 3.0 life years per 1,000 participants at a $101,000 cost savings for the society.
8. Screening and Early Protection Provides the Real Opportunity to Reduce Bladder Cancer Mortality
All individuals who die from their bladder cancer do so due to metastatic disease, and most patients have muscle-invasive cancers. Over 80 percent of muscle-invasive cancers are detected at initial diagnosis and in people who have no history of previous superficial tumors. So, the rationale for pushing early screening and detection of bladder cancer is for diagnosing cancers destined to become muscle-invasive before the invasion.
Reasons Why Patients Often Do Not Comply with Surveillance Following Bladder Cancer Treatment
So, what drives bladder cancer surveillance non-compliance?
- Lack of understanding of recurrence risk or monitoring techniques: Many patients don't understand the monitoring techniques or recurrence risk and therefore fail to comply with surveillance.
- Perception of risk: Many individuals have a low awareness of risk factors or subjective judgment as to the severity of the risks.
- Discomfort from standard cystoscopy: Many fear the pain and other side effects associated with cystoscopy.
- Fear of complications from standard cystoscopy: Many fear there will be complications from cystoscopy like urinary tract infection or blood in the urine, known as hematuria.
- Advanced age: This is often a factor in non-compliance because of the invasive nature of surveillance.
- Lower economic dwelling and urban dwelling: Being in a lower economic situation or living in a city also contribute to non-compliance.
- Cost: Bladder cancer detection and treatment can be costly which can be a factor in non-compliance.
- Patient attitudes: Many patients don't comply because of their beliefs or perceptions towards cystoscopy surveillance.
Options for Bladder Cancer Surveillance After Treatment
As a bladder cancer patient, you have several bladder cancer surveillance options after treatment. These include the following:
1. Urine Cytology
Urine cytology is a test that checks your urine for abnormal cells. Doctors use it with other procedures and tests for diagnosing urinary tract cancers, usually bladder cancer. Your doctor may suggest a urine cytology test if you're experiencing blood in your urine. For individuals who receive a bladder cancer diagnosis and have gone through treatment, this test could help with recurrence detection.
2. Cystoscopy (Invasive)
This is an invasive test that looks inside your bladder, checking for signs of cancer. It's the primary diagnostic procedure with bladder cancer. Your doctor uses a lighted, flexible, thin tube known as a cystoscope to look inside your body. The doctor can perform flexible cystoscopy in the office, and it may not require anesthesia. It's a short procedure used for detecting growths in your bladder to see if you need surgery or a biopsy.
3. Biopsy (Invasive)
If the doctor sees an abnormal area during cystoscopy, they'll need to biopsy it to determine if it's cancer. A biopsy is where the doctor takes out tiny pieces of abnormal-looking tissue to test for cancer cells. If they suspect bladder cancer, they'll need a biopsy to confirm the diagnosis.
Transurethral Resection of Bladder Tumor (TURBT) is the procedure the doctor uses to biopsy an abnormal area. Another name for this is a transurethral resection (TUR). The doctor removes the tumor during this procedure as well as some of the bladder muscle surrounding the tumor. They then send the extracted samples to the laboratory to test for cancer. If they find cancer, they will also test to see if it's spread into the muscle layer of your bladder wall.
4. Urine Culture
If you're experiencing urinary symptoms, a urine culture might be done to check for infection instead of cancer. Bladder cancer and urinary tract infections often cause the same symptoms. The doctor places a urine sample into a dish in the laboratory to allow any present bacteria to grow. It might take several days before getting the test results since it can take a little bit of time for bacteria to grow.
5. Imaging Studies (X-Ray or CT)
Imaging tests use magnetic fields, x-rays, radioactive substances or sound waves to generate images of your body's insides.
If your doctor determines you have bladder cancer, they might order some imaging tests to determine if the cancer has spread to organs or tissues near your bladder, to distant areas of your body or to nearby lymph nodes. If the doctor sees enlarged lymph nodes on the imaging test or other potential signs your cancer has spread, they may do a biopsy to confirm the findings.
6. Urine Tumor Marker Tests
Various urine tests check for certain substances the bladder cancer cells make. The doctor may use one or more of these tests along with urine cytology to determine if you have bladder cancer. Many physicians find these types of urine tests useful when they're looking for bladder cancer, but not in all cases. In some cases, this test is more helpful in finding a recurrence of bladder cancer rather than an initial diagnosis.
7. Fluorescence In Situ Hybridization (FISH)
Your doctor may use multitarget FISH to detect specific DNA alterations linked with bladder cancer, especially among bladder cancer patients who received cytology results that were atypical, negative or suggestive.
8. Non-Invasive Urine Tests (Urine Microscopy and Dipstick Test)
Microscopic and dipstick examination of urine allows your doctor to detect infection or hematuria. Hematuria can suggest the likelihood of a recurrence of bladder cancer.
Cxbladder Non-Invasive Bladder Cancer Urine Surveillance Tests
Cxbladder offers non-invasive urine tests for bladder cancer surveillance. Cxbladder tests a sample of urine for the gene expression levels of five biomarkers that represent a bladder cancer signature, allowing for the detection of the disease earlier than other procedures. In clinical trials, Cxbladder outperformed cytology and comparable urine tests, including FISH. This means it's sensitive enough for determining with high accuracy the likelihood of cancer.
The International Journal Urologic Oncology published a clinical and scientific paper that validates the Cxbladder Monitor test and its superior performance for surveillance and management of individuals following bladder cancer treatment. The paper compared the Cxbladder Monitor test's performance to cytology and other urine markers for surveillance of bladder cancer patients.
With over 1,100 U.S. patient samples, the study found the Cxbladder Monitor test significantly outperforms FDA-approved urine-based monitoring tests, including UroVysion® FISH and cytology.
Contact Cxbladder for More Information
If you're concerned about bladder cancer, you can put your mind at ease by having a urinary bladder test done. Cxbladder provides you with a non-invasive, reliable bladder cancer detection tool. Contact us today for more information on Cxbladderand talk with your doctor to see if Cxbladder can help rule out a diagnosis of bladder cancer for you.
Talk to your doctor
Are you alarmed about blood in your urine? Worried about bladder cancer? Here are some questions you can ask your doctor.Get the questions here
An online community where people affected by bladder cancer can share experiences and support each other in a safe, secure environment.Join the community today
Contact us by phone or email, or fill out an online form and a Cxbladder representative will get back to you.Complete an information request form today