Cancers Not Alike: Survival Improves with Aggressive
Treatment of Lung Cancer, Not Bladder Cancer
Both studies from U of Michigan illustrate the vast
differences in cancers and their treatment
April 13, 2009 For many senior citizens the word
cancer creates a vision of a life-threatening uncontrolled growth that
requires immediate and aggressive treatment by radiation and
chemotherapy they are all pretty much alike. But, two studies from the
University of Michigan last week illustrate that all cancers are not
alike. The first found more aggressive treatment did not help bladder
cancer victims survive. The second says higher doses of
radiation combined with chemotherapy improves survival in patients with
stage III lung cancer.
The first study involving bladder cancer reports
that despite enduring more invasive tests and medical procedures,
patients who were treated aggressively for early stage bladder cancer
had no better survival than patients who were treated less aggressively.
Further, the aggressively treated patients were more likely to undergo
major surgery to have their bladder removed, according to a new study
from researchers at the
University of Michigan Comprehensive Cancer Center.
Because
bladder cancer is often treated as a chronic disease requiring
lifelong surveillance, it is among the most expensive cancers to treat
in the United States. Urologists vary widely in how they approach early
stage, or non-muscle-invasive, bladder cancer.
In this study, researchers gathered data from the
Surveillance, Epidemiology and End Results Medicare database. They
looked at 940 doctors who provided care to 20,713 early stage bladder
cancer patients. Each doctor included in the study had treated at least
10 patients for bladder cancer.
Bladder cancer statistics: 68,810 Americans will be
diagnosed with bladder cancer this year and 14,100 will die from the
disease, according to the
American Cancer Society
The study found that average per-patient treatment
expenditures ranged from $2,830 for doctors in the low-intensity
treatment category to $7,131 for doctors in the high-intensity category.
At the same time, survival rates across all intensity categories were
similar.
What this indicates is that some doctors are
providing potentially unnecessary care, or care without measurable
benefit to the patient. It makes sense to many doctors and patients that
more would be better, but unfortunately there can be unintended
consequences of unneeded care, says study author
Brent Hollenbeck, M.D., M.S., assistant professor of urology at the
U-M Medical School.
The study found that patients treated more
aggressively had more imaging procedures and more invasive surgical
procedures. The aggressively treated patients were also nearly twice as
likely to require major medical interventions, and were 2.5 times more
likely to undergo radical
cystectomy, a procedure to remove the bladder.
The study authors suggest that certain patients
might still benefit from greater intensity of care, but further research
is needed to determine which patients would benefit. Hollenbeck also
urges randomized clinical trials to look at the value of some of the
more expensive and common health services to determine their optimal use
for patients with early stage bladder cancer.
Urologists should not assume that more aggressive
management of early stage bladder cancer will translate into better
outcomes for their patients. By reducing unnecessary health care, we can
reduce wasteful spending, which will lessen the cost burden of bladder
cancer, one of the most expensive cancers to treat from diagnosis to
death, Hollenbeck says.
Higher doses of radiation combined with
chemotherapy improve survival in patients with stage III lung cancer,
according to the second new study by researchers at the
University of Michigan Comprehensive Cancer Center.
Standard treatment for this stage of
lung cancer when the tumor is likely too large to be removed
through surgery involves a combination of
radiation therapy with chemotherapy. But, this new study finds,
giving chemotherapy at the same time as the radiation enhances the
effect of both. Further, increasing the dose of radiation over the
course of treatment also increased survival.
When patients are diagnosed with stage III lung
cancer, surgery is often not an option, and survival rates are typically
quite low. Finding new ways to improve survival, even in small
increments, is crucial, says senior study author
Feng-Ming Kong, M.D., Ph.D., associate professor of radiation
oncology at the
U-M Medical School and chief of radiation oncology at the
VA Ann Arbor Healthcare System.
Lung cancer statistics: 215,000 Americans will be
diagnosed with lung cancer this year and 161,800 will die from the
disease, according to the
American Cancer Society
The researchers compared survival among patients
treated with radiation alone, with radiation followed by chemotherapy,
and with radiation and chemotherapy given at the same time. Thirty-one
of the patients were also enrolled in a study in which the radiation
dose was increased throughout the course of the treatment.
Patients treated with radiation alone had the worst
overall survival rates, living only an average 7.4 months after
diagnosis. Adding chemotherapy increased survival to 14.9 months when it
was administered after completing radiation and 15.8 months when
administered at the same time as radiation.
After five years, 19.4 percent of the patients
receiving concurrent chemotherapy were still alive, compared to only 7.5
percent of patients receiving sequential chemotherapy.
Our study shows chemotherapy helps, and high dose
radiation helps. But its challenging to administer these treatments at
the same time because of the potential toxicity associated with the high
dose radiation, Kong says.
U-M researchers are currently looking at using
PET imaging during the course of lung cancer treatment to
personalize high dose radiation therapy in many individual patients.
As the tumor becomes smaller during treatment,
increasing the radiation dose will become more tolerable because it is
targeting a smaller area. The U-M researchers believe this strategy
could lead to improved treatment outcomes in many patients. Kong
currently leads a clinical trial that is following patients through
their treatment to look at the impact on survival of increasing
radiation dose.
