Researcher finds gaps in care for high-risk cancer patients
Christopher Booth (Queen’s Department of Oncology and Kingston General Hospital) has found that chemotherapy before or after surgery for high-risk bladder cancer is not commonly used in routine clinical practice despite the fact that it is shown to improve long-term survival by five per cent. He is now using those findings to better understand the barriers to using chemotherapy, with the goal of implementing a plan to improve treatment rates.
“Results from our study demonstrate that chemotherapy given after surgery improves patient survival—probably on the same order of magnitude as chemotherapy before surgery,” says Dr. Booth. “Patients having surgery for bladder cancer should have chemotherapy, either before or after surgery. Efforts are needed to improve uptake of this treatment, which appears to be vastly underutilized.”
To investigate, Dr. Booth, a member of the Cancer Research Institute at Queen’s University, examined treatment records of all 2,944 patients who had surgery for high-risk bladder cancer in Ontario between 1994 and 2008.
Use of chemotherapy before surgery remained stable (an average of four per cent of patients) over the study period despite international guidelines recommending its use. Despite more limited evidence supporting its use, chemotherapy after surgery increased over time: 16 per cent of patients between 1994 and 1998, 18 per cent between 1999 and 2003, and 22 per cent between 2004 and 2008. Study results showed that use of chemotherapy after surgery improved long-term survival by five per cent.
“The reasons for underutilization of chemotherapy in high-risk bladder cancer are not well understood. This problem is not unique to Ontario and has been identified by researchers in the United States and Europe,” says Dr. Booth. “It likely relates to a complex interaction between physician knowledge, beliefs and attitudes and patient preferences.
“More work is needed to understand what is driving this gap in care so that interventions to improve treatment delivery may be implemented in Ontario and beyond.”
The findings are published online in CANCER, a peer-reviewed journal of the American Cancer Society.