Muscle-Invasive Bladder Cancer in Non-Curative Patients: A Study on Survival and Palliative Care Needs - Beyond the Abstract
November 21, 2024
We conducted an analysis of patients diagnosed with MIBC who were either unable or unwilling to undergo curative therapy. We evaluated overall survival (OS) and cancer-specific survival (CSS) and examined their associations with various clinical variables. Additionally, we assessed emergency department visits and palliative procedures.
Biographies:
Felix Guerrero-Ramos, MD, PhD, FEBU, Urologist, Hospital Universitario 12 de Octubre, Madrid, Spain
Biographies:
Felix Guerrero-Ramos, MD, PhD, FEBU, Urologist, Hospital Universitario 12 de Octubre, Madrid, Spain
Read the Full Video Transcript
Felix Guerrero-Ramos: Hello, everybody, and thank you. Here today for the invitation to summarize our recently published study at Cancer Journal on palliative care needs, and survival of muscle-invasive bladder cancer patients who are deemed unsuited for radical therapy, like radical cystectomy or terminal therapy. We report on 142 patients in our institution who were diagnosed with muscle-invasive bladder cancer-- MIBC-- from Sauwong, and were deemed unsuitable or not candidates for curative therapies.
Most of the patients-- around 40% of them-- were ruled out for therapy due to comorbidities. Around 36% were ruled out due to advanced disease stage, and 17% of the patients were discarded for radical therapy due to age alone. What we find is that the median overall survival is only 10.6 months, and the median cancer specific survival of these patients is 11.9 months, highlighting that most of these patients will die due to their bladder cancer, and they don't have a large survival in this setting.
We also analyze how many times they needed to visit the emergency room from the diagnosis of the muscle-invasive bladder cancer, and taking the decision of not doing an aggressive therapy until their death. And these patients attended the emergency room, I mean, an average of three times, with a mean hospitalization length around 3.4 days. We also analyze the palliative procedures they needed, and the most frequent palliative procedures was nephrostomy catheter in some of the patients-- 26% of them.
19% of the patients needed a palliative TURBT, and around 15% of the patients needed radiotherapy due to local complications of the bladder cancer. At the multivariate analysis, we would like to point out that we found hydronephrosis as a worst survival predictor. This had already been demonstrated for those patients undergoing radical cystectomy, but this had not been previously shown for patients who are ruled out for curative therapy.
We also found in this multivariate analysis that patients who were ruled out from aggressive therapy due to age alone have a better survival than the rest of the patients. So one of the main messages of our paper is that age alone should not be an exclusion criterion to take into account an aggressive therapy in these patients, as we see that age alone is not a predictor of worse survival.
And we also highlight the unmet need of this group of patients for whom there is not a curative approach. And the only thing you can do is follow them up, and doing palliative care procedures and contacting with your palliative care department. Thank you very much for watching.
Felix Guerrero-Ramos: Hello, everybody, and thank you. Here today for the invitation to summarize our recently published study at Cancer Journal on palliative care needs, and survival of muscle-invasive bladder cancer patients who are deemed unsuited for radical therapy, like radical cystectomy or terminal therapy. We report on 142 patients in our institution who were diagnosed with muscle-invasive bladder cancer-- MIBC-- from Sauwong, and were deemed unsuitable or not candidates for curative therapies.
Most of the patients-- around 40% of them-- were ruled out for therapy due to comorbidities. Around 36% were ruled out due to advanced disease stage, and 17% of the patients were discarded for radical therapy due to age alone. What we find is that the median overall survival is only 10.6 months, and the median cancer specific survival of these patients is 11.9 months, highlighting that most of these patients will die due to their bladder cancer, and they don't have a large survival in this setting.
We also analyze how many times they needed to visit the emergency room from the diagnosis of the muscle-invasive bladder cancer, and taking the decision of not doing an aggressive therapy until their death. And these patients attended the emergency room, I mean, an average of three times, with a mean hospitalization length around 3.4 days. We also analyze the palliative procedures they needed, and the most frequent palliative procedures was nephrostomy catheter in some of the patients-- 26% of them.
19% of the patients needed a palliative TURBT, and around 15% of the patients needed radiotherapy due to local complications of the bladder cancer. At the multivariate analysis, we would like to point out that we found hydronephrosis as a worst survival predictor. This had already been demonstrated for those patients undergoing radical cystectomy, but this had not been previously shown for patients who are ruled out for curative therapy.
We also found in this multivariate analysis that patients who were ruled out from aggressive therapy due to age alone have a better survival than the rest of the patients. So one of the main messages of our paper is that age alone should not be an exclusion criterion to take into account an aggressive therapy in these patients, as we see that age alone is not a predictor of worse survival.
And we also highlight the unmet need of this group of patients for whom there is not a curative approach. And the only thing you can do is follow them up, and doing palliative care procedures and contacting with your palliative care department. Thank you very much for watching.