Bladder Cancer: So Much Cost, Such Little Progress

LONDON, March 20, 2014 /PRNewswire/ --



The alarming truth about the huge financial and personal impact of bladder cancer is highlighted in a new paper published in European  Urology^[1]. The UK charity, Action on Bladder Cancer, co-authors an editorial^[2] on the paper, drawing attention to the urgent need to address the enormous, yet largely ignored, burden that this distressing disease places on individuals and society.

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Bladder cancer has the highest lifetime treatment costs per patient of all cancers^[3]. The direct medical costs of cancer care in the UK are £65M^[4]. As the seventh most common cancer in the UK, bladder cancer accounts for 1 in 30 new cases of cancer each year^[5]. Even so, outcomes for bladder cancer have changed little for three decades, despite significant improvements in the 5-year survival rates for prostate and kidney cancers during this same period^[2].

Bladder cancer has a deep and devastating reach into the health of our society. Overall, deaths from the disease remain higher in England than other European countries with similar incidence rates and survival is worsening^[6].  On average 14 people die each day from bladder cancer^[4], and yet it is largely neglected by those who could make a difference to the lives of so many people.

The paper and editorial discuss the key issues which are creating and sustaining this unacceptable situation:

• There are large gaps in our knowledge regarding the efficacy and cost-effectiveness of treatment approaches
• There is a lack of research funding compared to other cancers; despite being the seventh most common cancer, bladder cancer receives just 0.6% of NCRI cancer research spending in the UK^[7]
• There is a lack of sufficient randomized controlled trials (RCTs). RCTs provide the strongest evidence on which clinicians can base their practice however only 238 RCTs were published for bladder cancer between 1995 and 2010^[8].
• There is a clear and urgent need for the development of new drugs for bladder cancer.

As a result, bladder cancer still does not have a robust evidence base to support much of what is current everyday practice. Patient pathways of care are complex and prolonged, resulting in large variations in practice worldwide. Even at the basic level of public awareness of the disease, many people have not heard of bladder cancer and do not recognise that even just one episode of visible blood in the urine may indicate that bladder cancer may be present. For many people, diagnosis is delayed or misdiagnosed resulting in worse clinical outcomes. This is clearly just not good enough.

Mr Richard T Bryan, Chief Investigator, Bladder Cancer Prognosis Programme, and Senior Research Fellow, University of Birmingham, and Action on Bladder Cancer Regional Advisor says "The review by Svatek et al demonstrates the huge costs associated with the diagnosis and management of bladder cancer, the large variations in practice worldwide, and the significant gaps in our knowledge. Our accompanying editorial expands on these themes and others; most importantly, the lack of improvement in outcomes for bladder cancer patients over the last three decades, the poor funding for bladder cancer research, and the poor awareness of bladder cancer amongst the general public and the non-urologic scientific community. We need to advance the cause for bladder cancer patients and make much more progress with this very common disease."

Bladder cancer lags starkly behind nearly all other cancers. Action needs to be taken now to improve the life expectancy of so many people with bladder cancer. Quite simply, more has to be done.

About  Action  on  Bladder  Cancer 

Action on Bladder Cancer is a UK charity working to improve public awareness, medical knowledge and the priority of bladder cancer on the UK health agenda, to ensure earlier recognition and diagnosis and so allow more effective management to improve the outcomes for people with bladder cancer. (http://www.actiononbladdercancer.org).

References:

1. Svatek et al. The Economics of Bladder Cancer: Costs and Considerations of Caring for This Disease. European Urology. Published online Feb 2014. Abstract available at: http://www.europeanurology.com/article/S0302-2838(14)00018-9/abstract/the-economics-of-bladder-cancer-costs-and-considerations-of-caring-for-this-disease
2. Bryan RT et al. So much cost, such little progress. European Urology. Published online Feb 2014.  http://www.europeanurology.com/article/S0302-2838(14)00160-2/abstract
3. Sievert KD et al. Economic aspects of bladder cancer. What are the benefits and costs? World  J  Urol. Jun 2009; 27(3): 295-300.
4. Mowatt G, Zhu S, Kilonzo M, Boachie C, Fraser C, Griffiths TR, N'Dow J, Nabi G, Cook J, Vale L. Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer. Health Technol Assess 2010; 14:1-iv
5. Cancer Research UK, Cancer Stats Key Facts, Bladder Cancer http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/bladder-cancer/uk-bladder-cancer-statistics
6. Eylert MF et al (2014). Falling bladder cancer incidence from 1990 to 2009 is not producing universal mortality improvements. Journal  of  Clinical  Urology 0(0) 1-9
7. National Cancer Research Institute. NCRI spend by cancer site.  Available at http://www.ncri.org.uk/what-we-do/research-database
8. Bachir, B. G., Shariat, S. F., Zlotta, A., Svatek, R., Black, P. C., Shah, J. B., Kassouf, W., Bladder Cancer Think Tank (Bladder Cancer Advocacy Network) and Canadian Bladder Cancer Network (Bladder Cancer Canada) (2013), Demographic analysis of randomized controlled trials in bladder cancer.  BJU  International, 111: 419-426