Bladder cancer is a common malignancy with treatment options dependent on both disease severity and patient factors. Superficial disease can be managed with local therapies while more advanced disease may require surgery or radiotherapy. Chemotherapy can be used across a range of disease stages. Correspondingly, pathways of care can be complex and there is little Australian literature on patterns of care.
The Evaluation of Cancer Outcomes (ECO) Registry records clinical and treatment information on all newly diagnosed cancer patients in the Barwon South West Region (BSWR) of Victoria encompassing approximately 380,000 people. This study analysed patterns of care and outcomes for all BSWR bladder cancer patients diagnosed within 100 km of Geelong from 2009 to 2015.
Over the 7 year period 260 patients were diagnosed with bladder cancer. The median age at diagnosis was 74.93 (range 45-98) and 192 (73.8%) were male while 169 (65%) had a smoking history. Stage as abstracted from the medical record was; I (21%), II (19%), III (10%), IV (11%) and unrecorded (39%). Trans-urethral resection of bladder tumour (TURBT) was performed in 129 patients (49.6%) and was the only intervention in 32 patients (12.2%). Intra-vesical treatment details were not available. Higher stage disease generally underwent more aggressive therapy with cystectomy in 30 patients (11.5%) and radical radiotherapy in 24 patients (9.2%). Chemotherapy was administered to 64 patients (24.6%) and 54 patients (20.8%) underwent palliative radiotherapy. Median survival of the entire cohort was 26 months and was stage dependent (stages I, II, III, IV, unrecorded – 62, 23, 21, 7 and 30 months respectively).
This population based analysis of bladder cancer has shown that care pathways can be complex with patients often receiving different modalities of treatment and requiring input from multiple specialties. Both treatment patterns and survival are heavily stage dependent.