Cancer specialists and researchers at Princess Margaret Hospital, University Health Network (UHN), are tackling an ongoing controversy about the best way to treat an aggressive form of bladder cancer – immediate radical surgery or a more conservative initial approach using immunotherapy?
To answer that question, Drs. Girish Kulkarni, Shabbir Alibhai and colleagues calculated the life expectancy and the quality of life expected from the two treatment methods. The team used a decision-analysis tool – the Markov model – a first for this form of bladder cancer.
The results will be released Sept. 25 in PloS Medicine , the journal of the Public Library of Science, which is a peer-reviewed, open-access journal that publishes original research relevant to improving human health.
Cystectomy – the surgical removal of the bladder – is considered an excellent treatment to cure this form of bladder cancer. In some cases, a new bladder is fashioned from part of the bowel. In others, an opening is created to collect urine in a pouch outside the body. Immunotherapy uses bacillus Calmette-Guerin (BCG; the tuberculosis bacterium) to treat cancer cells directly in the bladder and avoids the need for a major operation. BCG stimulates an immune response that diminishes the risk of tumour recurrence and/or progression. The researchers compared the pros and cons of each treatment in their model.
The findings demonstrate that patients under the age of 60 who opt for immediate surgery can live longer with a higher quality of life than if they had chosen the more conservative option. On the other hand, the better choice for patients over age 70 with other health issues – or for those who place a high value on retaining sexual function and avoiding other side effects of surgery that may impair quality of life – was the more conservative initial approach using immunotherapy.
More importantly, the study identified the major quality of life factors that should be discussed with patients when choosing between these treatment options.