20 Years of Bladder Cancer Research in the West Midlands: A Comparison of Two Large Cohorts

Abstract Introduction The British Association of Urological Surgeons (BAUS) issued an interim strategy for the management of bladder cancer as a contingency measure during the COVID-19 pandemic. We aim to assess the actual implementation of these recommendations and deviation from the standard of care in the West Midlands. Method A questionnaire was devised and sent to bladder cancer leads of 12 NHS Trusts in the region in June 2020. Responses were analysed and compared with the BAUS COVID-19 strategy. Results 11 centres were aware of the BAUS COVID-19 strategy. 2 centres were offering teleconsultations only for 2-week-wait referrals, and 6 centres had changed their practice for non-visible haematuria referrals. All centres were offering TURBTs for new and high-risk tumours. 8 centres had clear MDT documentation of NICE risk-stratifications of all bladder tumours and 10 centres were also documenting any changes in treatment. Only 7 centres continued to give BCG to newly diagnosed NMIBC. All centres continued with staging CT for newly diagnosed MIBC. Patients were still being referred for cystectomies, however few were performed. Radiation as curative and palliative intent continued. Of the 5 regional cancer centres, only 1 continued with cystectomies as normal, whereas 2 performed the procedure on a case-by-case basis, and the procedure was delayed/deferred in the other 2 centres. Conclusions Diagnostics, and definitive management of bladder cancer has been severely affected by COVID-19. In particular, deferred intravesical BCG and delayed radical treatment can have a dire impact on the long-term outcomes of the patients presenting during the pandemic.

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Muscle invasive bladder cancer in the elderly: Treatment and prognosis in a prospective cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.275 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 275-275 ◽

Cited By ~ 1

Author(s):

Stephanie Slater ◽

Thomas Wright ◽

Adam Devall ◽

Sarah Pirrie ◽

Lucinda Billingham ◽

...

Keyword(s):

Bladder Cancer ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

The Elderly ◽

Newly Diagnosed ◽

The West ◽

Muscle Invasive Bladder Cancer ◽

West Midlands ◽

Muscle Invasive

275 Background: As the prevalence of bladder cancer increases amongst the elderly, nearly 1 in 3 muscle invasive bladder cancer (MIBC) cases are in patients aged >80 years (Taylor JA, III, Kuchel GA. Nat Clin Pract Urol 2009; 6(3):135-1440). However, radical cystectomy remains as the gold standard treatment for MIBC (Yafi FA, Kassouf W. Can Urol Assoc J 2009; 3(5):409-412). In this study we examined treatment patterns and outcomes patients aged >80 years from a prospective study of bladder cancer. Methods: The Bladder Cancer Prognosis Programme (BCPP) is a 5 year prospective cohort study (2006-2011) with 1191 patients confirmed as having newly-diagnosed bladder cancer. Recruitment took place at 9 urological centres within the West Midlands region, UK. From this cohort we identified 67 patients aged >/=80 years with newly diagnosed MIBC. Study records include overall and disease specific survival, time to disease recurrence and radiotherapy (RT) treatment. Simple descriptive statistics were used to describe the outcomes. Results: This cohort consisted of 46 male and 21 female patients with a median age of 83 (IQR=81, 87; range=80, 94). Only 4 (6%) patients underwent cystectomy and 36 (53%) underwent RT. Median survival data is summarised in the table below. Conclusions: Despite guidelines, practising urologists in the West Midlands region do not offer cystectomy to the vast majority of MIBC patients aged >80 years. Furthermore, in this patient cohort, OS was shorter than BCSS by 10 months, suggesting that quality of life after diagnosis will be far more important than cure rates due to deaths from other causes. Of particular note is that the group receiving RT had longer OS and BCSS than the rest of the cohort. This indicates that RT could be a far more appropriate standard of care in the elderly than surgery, which is clearly of limited applicability in this growing demographic. Clinical trial information: 06/MRE04/65. [Table: see text]

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