1
|
Zhang Q, Fu S, Li X, Wang H, Wang J. STAT1 as a potential therapeutic target to treat bladder cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2024; 17:298-307. [PMID: 39399655 PMCID: PMC11470427 DOI: 10.62347/hycn1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/10/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Previous studies have reported that STAT1 (Signal Transducer and Activator of Transcription 1) is associated with multiple tumor progression. This study aimed to investigate the role and related mechanisms of STAT1 in bladder cancer. METHODS STAT1 expression in bladder cancer tissues and human bladder cancer cell lines was assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The bladder cancer cell line T24 was transfected with overexpressing lentivirus targeting STAT1. Cell proliferation, invasion, and apoptosis were measured by Cell Counting Kit-8, Transwell assays, and flow cytometric analysis. Furthermore, RNA-Seq was performed to identify the downstream signaling pathways. Finally, the signaling pathway-related molecules were determined by RT-qPCR and western blot assays. RESULTS The overexpression of STAT1 inhibited bladder cancer cell proliferation and invasion while enhancing apoptosis. Moreover, the overexpression of STAT1 in bladder cancer cells delayed tumor tumorigenesis in vitro. Mechanistically, RNA-Seq analysis revealed that the JAK-STAT signaling pathway was up-regulated, especially SOCS1 (suppressor of cytokine signaling 1) and SOCS3 (suppressor of cytokine signaling 3) in STAT1-sufficient cells. CONCLUSIONS These results indicate the potential of STAT1 as a therapeutic target in bladder cancer.
Collapse
Affiliation(s)
- Qin Zhang
- Department of Gynaecology, The Second Affiliated Hospital of Kunming Medical UniversityKunming 650101, Yunnan, China
| | - Shi Fu
- Department of Gynaecology, The Second Affiliated Hospital of Kunming Medical UniversityKunming 650101, Yunnan, China
| | - Xiaotao Li
- Department of Andriatrics, The Second Affiliated Hospital of Kunming Medical UniversityKunming 650101, Yunnan, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of UrologyKunming 650101, Yunnan, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of UrologyKunming 650101, Yunnan, China
| |
Collapse
|
2
|
Liedberg F, Gårdmark T, Hagberg O, Aljabery F, Ströck V, Hosseini A, Malmström PU, Söderkvist K, Ullén A, Jerlström T, Jahnson S, Holmberg L, Häggström C. Treatment Related to Urinary Tract Infections Is Associated with Delayed Diagnosis of Urinary Bladder Cancer: A Nationwide Population-based Study. Eur Urol Oncol 2024:S2588-9311(24)00181-0. [PMID: 39143001 DOI: 10.1016/j.euo.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND AND OBJECTIVE It has been suggested that urinary tract infections (UTIs) are associated with delayed diagnosis of bladder cancer (BC). Our aim was to investigate prediagnostic treatments related to UTI and the relation to BC diagnostic delay, reflected by advanced disease at diagnosis. METHODS We used data from the BladderBaSe 2.0 with data of treatments related to UTI up to 3 yr before BC diagnosis (2008-2019) for BC patients in comparison to a matched reference population. We investigated the association between UTI treatments and more advanced disease at diagnosis in the BC cohort. We used generalized ordered logistic regression to calculate odds ratios (ORs) for more advanced disease as an ordered outcome: non-muscle-invasive BC (NMIBC), muscle-invasive BC (MIBC), and metastatic BC (MBC). KEY FINDINGS AND LIMITATIONS The study population included 29 921 BC patients and 149 467 matched reference subjects. The proportions of individuals receiving UTI treatment were higher in the patient groups than in the corresponding reference groups, with the greatest differences observed for the MIBC and MBC subgroups. The OR for the risk of more advanced disease (MIBC or MBC) with at least one UTI treatment versus none was 1.28 (95% confidence interval [CI] 1.19-1.37) for men and 1.42 (95 % CI 1.27-1.58) for women. The association to risk of more advanced disease increased with the number of UTI treatments for both sexes. CONCLUSIONS AND CLINICAL IMPLICATIONS Further studies on the effects of treatments related to UTI in combination with other factors are needed to identify reasons for possible delays in the BC diagnostic pathway. PATIENT SUMMARY We found that for patients with bladder cancer, previous antibiotic treatment for a urinary tract infection was linked to more advanced disease at diagnosis. Further studies are needed to identify reasons for possible delays in the diagnosis of bladder cancer.
Collapse
Affiliation(s)
- Fredrik Liedberg
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Oskar Hagberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Viveka Ströck
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Per-Uno Malmström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Söderkvist
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Northern Registry Centre, Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden.
| |
Collapse
|
3
|
Wiegand AA, Sheikh T, Zannath F, Trudeau NM, Dukhanin V, McDonald KM. "It's probably an STI because you're gay": a qualitative study of diagnostic error experiences in sexual and gender minority individuals. BMJ Qual Saf 2024; 33:432-441. [PMID: 37164638 DOI: 10.1136/bmjqs-2022-015629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND There is a critical need to identify specific causes of and tailored solutions to diagnostic error in sexual and gender minority (SGM) populations. PURPOSE To identify challenges to diagnosis in SGM adults, understand the impacts of patient-reported diagnostic errors on patients' lives and elicit solutions. METHODS Qualitative study using in-depth semistructured interviews. Participants were recruited using convenience and snowball sampling. Recruitment efforts targeted 22 SGM-focused organisations, academic centres and clinics across the USA. Participants were encouraged to share study details with personal contacts. Interviews were analysed using codebook thematic analysis. RESULTS Interviewees (n=20) ranged from 20 to 60 years of age with diverse mental and physical health symptoms. All participants identified as sexual minorities, gender minorities or both. Thematic analysis revealed challenges to diagnosis. Provider-level challenges included pathologisation of SGM identity; dismissal of symptoms due to anti-SGM bias; communication failures due to providers being distracted by SGM identity and enforcement of cis-heteronormative assumptions. Patient-level challenges included internalised shame and stigma. Intersectional challenges included biases around factors like race and age. Patient-reported diagnostic error led to worsening relationships with providers, worsened mental and physical health and increased self-advocacy and community-activism. Solutions to reduce diagnostic disparities included SGM-specific medical education and provider training, using inclusive language, asking questions, avoiding assumptions, encouraging diagnostic coproduction, upholding high care standards and ethics, involving SGM individuals in healthcare improvement and increasing research on SGM health. CONCLUSIONS Anti-SGM bias, queerphobia, lack of provider training and heteronormative attitudes hinder diagnostic decision-making and communication. As a result, SGM patients report significant harms. Solutions to mitigate diagnostic disparities require an intersectional approach that considers patients' gender identity, sexual orientation, race, age, economic status and system-level changes.
Collapse
Affiliation(s)
- Aaron A Wiegand
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Vadim Dukhanin
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn M McDonald
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
4
|
Drożdż A, Duggan B, Ruddock MW, Reid CN, Kurth MJ, Watt J, Irvine A, Lamont J, Fitzgerald P, O’Rourke D, Curry D, Evans M, Boyd R, Sousa J. Stratifying risk of disease in haematuria patients using machine learning techniques to improve diagnostics. Front Oncol 2024; 14:1401071. [PMID: 38779086 PMCID: PMC11109371 DOI: 10.3389/fonc.2024.1401071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Detailed and invasive clinical investigations are required to identify the causes of haematuria. Highly unbalanced patient population (predominantly male) and a wide range of potential causes make the ability to correctly classify patients and identify patient-specific biomarkers a major challenge. Studies have shown that it is possible to improve the diagnosis using multi-marker analysis, even in unbalanced datasets, by applying advanced analytical methods. Here, we applied several machine learning algorithms to classify patients from the haematuria patient cohort (HaBio) by analysing multiple biomarkers and to identify the most relevant ones. Materials and methods We applied several classification and feature selection methods (k-means clustering, decision trees, random forest with LIME explainer and CACTUS algorithm) to stratify patients into two groups: healthy (with no clear cause of haematuria) or sick (with an identified cause of haematuria e.g., bladder cancer, or infection). The classification performance of the models was compared. Biomarkers identified as important by the algorithms were also analysed in relation to their involvement in the pathological processes. Results Results showed that a high unbalance in the datasets significantly affected the classification by random forest and decision trees, leading to the overestimation of the sick class and low model performance. CACTUS algorithm was more robust to the unbalance in the dataset. CACTUS obtained a balanced accuracy of 0.747 for both genders, 0.718 for females and 0.803 for males. The analysis showed that in the classification process for the whole dataset: microalbumin, male gender, and tPSA emerged as the most informative biomarkers. For males: age, microalbumin, tPSA, cystatin C, BTA, HAD and S100A4 were the most significant biomarkers while for females microalbumin, IL-8, pERK, and CXCL16. Conclusions CACTUS algorithm demonstrated improved performance compared with other methods such as decision trees and random forest. Additionally, we identified the most relevant biomarkers for the specific patient group, which could be considered in the future as novel biomarkers for diagnosis. Our results have the potential to inform future research and provide new personalised diagnostic approaches tailored directly to the needs of the individuals.
Collapse
Affiliation(s)
- Anna Drożdż
- Personal Health Data Science Group, Sano – Centre for Computational Personalised Medicine - International Research Foundation, Krakow, Poland
| | - Brian Duggan
- South Eastern Health and Social Care Trust, Ulster Hospital Dundonald, Belfast, United Kingdom
| | - Mark W. Ruddock
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Cherith N. Reid
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Joanne Watt
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Allister Irvine
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - John Lamont
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Peter Fitzgerald
- Clinical Studies Group, Randox Laboratories Ltd., Co., Antrim, United Kingdom
| | - Declan O’Rourke
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - David Curry
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Mark Evans
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Ruth Boyd
- Northern Ireland Clinical Trials Network, Belfast City Hospital, Belfast, United Kingdom
| | - Jose Sousa
- Personal Health Data Science Group, Sano – Centre for Computational Personalised Medicine - International Research Foundation, Krakow, Poland
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University, Belfast, United Kingdom
| |
Collapse
|
5
|
Bilski K, Żeber-Lubecka N, Kulecka M, Dąbrowska M, Bałabas A, Ostrowski J, Dobruch A, Dobruch J. Microbiome Sex-Related Diversity in Non-Muscle-Invasive Urothelial Bladder Cancer. Curr Issues Mol Biol 2024; 46:3595-3609. [PMID: 38666955 PMCID: PMC11048804 DOI: 10.3390/cimb46040225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Sex-specific discrepancies in bladder cancer (BCa) are reported, and new studies imply that microbiome may partially explain the diversity. We aim to provide characterization of the bladder microbiome in both sexes diagnosed with non-muscle-invasive BCa with specific insight into cancer grade. In our study, 16S rRNA next-generation sequencing was performed on midstream urine, bladder tumor sample, and healthy-appearing bladder mucosa. Bacterial DNA was isolated using QIAamp Viral RNA Mini Kit. Metagenomic analysis was performed using hypervariable fragments of the 16S rRNA gene on Ion Torrent Personal Genome Machine platform. Of 41 sample triplets, 2153 taxa were discovered: 1739 in tumor samples, 1801 in healthy-appearing bladder mucosa and 1370 in midstream urine. Women were found to have smaller taxa richness in Chao1 index than men (p = 0.03). In comparison to low-grade tumors, patients with high-grade lesions had lower bacterial diversity and richness in urine. Significant differences between sexes in relative abundance of communities at family level were only observed in high-grade tumors.
Collapse
Affiliation(s)
- Konrad Bilski
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Prof. W. Orlowski, 00-416 Warsaw, Poland;
| | - Natalia Żeber-Lubecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre for Postgraduate Medical Education, 02-781 Warsaw, Poland; (N.Ż.-L.); (M.K.); (J.O.)
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.); (A.B.)
| | - Maria Kulecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre for Postgraduate Medical Education, 02-781 Warsaw, Poland; (N.Ż.-L.); (M.K.); (J.O.)
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.); (A.B.)
| | - Michalina Dąbrowska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.); (A.B.)
| | - Aneta Bałabas
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.); (A.B.)
| | - Jerzy Ostrowski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre for Postgraduate Medical Education, 02-781 Warsaw, Poland; (N.Ż.-L.); (M.K.); (J.O.)
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.); (A.B.)
| | | | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Prof. W. Orlowski, 00-416 Warsaw, Poland;
| |
Collapse
|
6
|
Rosenbaum CM, Filmar S, Gross AJ, Jobst N, Schultz A. The influence of socioeconomic status and gender on incidence and survival in bladder cancer: a longitudinal study based on the Hamburg Cancer Registry. World J Urol 2024; 42:166. [PMID: 38492172 DOI: 10.1007/s00345-024-04888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND To investigate the influence of socioeconomic status (SES) and gender on the incidence and survival of patients with bladder cancer on a small scale within the city of Hamburg, Germany. METHODS Patients documented in the Hamburg Cancer Registry aged ≥ 18 years with primary bladder carcinoma (ICD-10: C67, D09.0), diagnosed in the period 2004-2020 (follow-up until 31.12.2021), and residing in Hamburg were included. The patients were divided into three groups (low, intermediate, and high SES) based on the socioeconomic situation at the district level, defined by the proportion of unemployed individuals, social housing, benefit recipients according to law, etc. Relative survival in the years 2004-2020 was calculated using a period approach. RESULTS Among the 10,659 patients included, age-standardized 5-year relative survival (5YRS) in 2004-2020 correlated with SES. The age-standardized 5YRS differed significantly between patients with high and intermediate SES vs low SES. Women with low SES had the worst 5YRS at 58.2%, while men with high SES presented the best relative 5YRS at 73.5%. This effect remained after stratification by UICC stages. Concerning incidence, there is an indication that women with low SES were more often diagnosed in higher UICC stages III or IV than women with high SES (18.3% versus 12.6%). CONCLUSIONS The socioeconomic situation at the time of diagnosis, as well as gender, has a substantial impact on the incidence and cancer survival rates in patients with bladder cancer. Further research, including the study of patient care, is needed to better understand and address these inequalities.
Collapse
Affiliation(s)
- Clemens M Rosenbaum
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
| | - Simon Filmar
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | | | | |
Collapse
|
7
|
Jackson SS, Pfeiffer RM, Hsieh MC, Li J, Madeleine MM, Pawlish KS, Zeng Y, Yu KJ, Engels EA. Sex differences in cancer incidence among solid organ transplant recipients. J Natl Cancer Inst 2024; 116:401-407. [PMID: 37944040 PMCID: PMC10919340 DOI: 10.1093/jnci/djad224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Males have 2-3-fold greater risk of cancer than females at most shared anatomic sites, possibly reflecting enhanced immune surveillance against cancer in females. We examined whether these sex differences remained among immunocompromised adults. METHODS Using the Transplant Cancer Match (TCM) study, we estimated the male-to-female incidence rate ratio in TCM (M:F IRRTransplant) for 15 cancer sites diagnosed between 1995 and 2017 using Poisson regression. Male to female IRRs in the general population (M:F IRRGP) were calculated using expected cancer counts from the Surveillance, Epidemiology, and End Results Program, standardized to the transplant population on age, race and ethnicity, and diagnosis year. Male to female IRRs were compared using a chi-square test. RESULTS Among 343 802 solid organ transplants, 211 206 (61.4%) were among men and 132 596 (38.6%) among women. An excess cancer incidence in males was seen in transplant recipients, but the sex difference was attenuated for cancers of the lip (M:F IRRTransplant: 1.81 vs M:F IRRGP: 3.96; P < .0001), stomach (1.51 vs 2.09; P = .002), colorectum (0.98 vs 1.43; P < .0001), liver (2.39 vs 3.44; P = .002), kidney (1.67 vs 2.24; P < .0001), bladder (2.02 vs 4.19; P < .0001), Kaposi sarcoma (1.79 vs 3.26; P = .0009), and non-Hodgkin lymphoma (1.34 vs 1.64; P < .0001). The M:F IRRTransplant was not statistically different from the M:F IRRGP for other cancer sites. CONCLUSIONS Although male solid organ transplant recipients have higher cancer incidence than female recipients, the attenuation in the male to female ratio for many cancers studied relative to the general population might suggest the importance of immunosurveillance, with some loss of advantage in female recipients due to immunosuppression after transplantation.
Collapse
Affiliation(s)
- Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jie Li
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA
| | - Margaret M Madeleine
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Karen S Pawlish
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA
| | - Yun Zeng
- University of North Dakota Department of Pathology, North Dakota Statewide Cancer Registry, Grand Forks, ND, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
8
|
Funston G, Moullet M, Mounce L, Lyratzopoulos G, Walter FM, Zhou Y. Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data study. Br J Gen Pract 2024; 74:e149-e155. [PMID: 38164573 PMCID: PMC10764107 DOI: 10.3399/bjgp.2023.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/14/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Understanding pre-diagnostic prescribing activity could reveal windows during which more timely cancer investigation and detection may occur. AIM To examine prescription patterns for common urological clinical features prior to renal and bladder cancer diagnoses. DESIGN AND SETTING A retrospective cohort study was performed using electronic primary care and cancer registry data on patients with bladder and renal cancer, who received their diagnosis between April 2012 and December 2015 in England. METHOD Primary care prescriptions up to 2 years pre- diagnosis were analysed for five groups of clinical features (irritative urological symptoms, obstructive symptoms, urinary tract infections [UTIs], genital infections, and atrophic vaginitis). Poisson regressions estimating the inflection point from which the rate of prescriptions increased from baseline were used to identify the start of diagnostic windows during which cancer could be detected. RESULTS A total of 48 094 prescriptions for 5322 patients were analysed. Inflection points for an increase in UTI prescriptions were identified 9 months pre- diagnosis for renal (95% confidence interval [CI] = 5.3 to 12.7) and bladder (95% CI = 7.4 to 10.6) cancers. For bladder cancer, the change in UTI antibiotic prescription rates occurred 4 months earlier in females (11 months pre- diagnosis, 95% CI = 9.7 to 12.3) than in males (7 months pre-diagnosis, 95% CI = 5.4 to 8.6). For other clinical features, no inflection points were identified and, as such, no diagnostic windows could be defined. CONCLUSION Prescription rates for UTIs increased 9 months before bladder and renal cancer diagnoses, indicating that there is potential to expedite diagnosis of these cancers in patients presenting with features of UTI. The greatest opportunity for more timely diagnosis may be in females with bladder cancer, who experienced the earliest increase in UTI prescription rate.
Collapse
Affiliation(s)
- Garth Funston
- Department of Public Health and Primary Care, University of Cambridge, Cambridge; Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Marie Moullet
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Luke Mounce
- University of Exeter Medical School, University of Exeter, Exeter
| | | | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Yin Zhou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge; Wolfson Institute of Population Health, Queen Mary University of London, London
| |
Collapse
|
9
|
Zhu S, Zhao H. Sexual dimorphism in bladder cancer: a review of etiology, biology, diagnosis, and outcomes. Front Pharmacol 2024; 14:1326627. [PMID: 38283839 PMCID: PMC10811034 DOI: 10.3389/fphar.2023.1326627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Bladder carcinoma represents a prevalent malignancy, wherein the influence of sex extends across its incidence, biological attributes, and clinical outcomes. This scholarly exposition meticulously examines pertinent investigations, elucidating the nuanced impact of sex on bladder cancer, and posits cogent avenues for future research and intervention modalities. In the initial discourse, an exhaustive scrutiny is undertaken of the etiological underpinnings of bladder cancer, encompassing variables such as tobacco consumption, occupational exposures, and genetic aberrations. Subsequently, a comprehensive dissection unfolds, delving into the intricate biological disparities inherent in sex vis-à-vis the initiation and progression of bladder cancer. This analytical framework embraces multifaceted considerations, spanning sex hormones, sex chromosomal dynamics, metabolic enzymatic cascades, and the intricate interplay with the microbiome. Lastly, a synthesized exposition encapsulates the ramifications of gender differentials on the diagnostic and prognostic landscapes of bladder cancer, underscoring the imperative for intensified investigative endeavors directed towards elucidating gender-specific variances and the formulation of tailored therapeutic strategies.
Collapse
Affiliation(s)
- Sheng Zhu
- Department of Urology, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, China
| | - Huasheng Zhao
- Department of Urology, ShaoYang Hosptial, Affiliated to University of South China, ShaoYang, China
| |
Collapse
|
10
|
Kashkoush J, Gupta M, Meissner MA, Nielsen ME, Kirchner HL, Garg T. Performance Characteristics of a Rule-Based Electronic Health Record Algorithm to Identify Patients with Gross and Microscopic Hematuria. Methods Inf Med 2023; 62:183-192. [PMID: 37666279 DOI: 10.1055/a-2165-5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Two million patients per year are referred to urologists for hematuria, or blood in the urine. The American Urological Association recently adopted a risk-stratified hematuria evaluation guideline to limit multi-phase computed tomography to individuals at highest risk of occult malignancy. OBJECTIVES To understand population-level hematuria evaluations, we developed an algorithm to accurately identify hematuria cases from electronic health records (EHRs). METHODS We used International Classification of Diseases (ICD)-9/ICD-10 diagnosis codes, urine color, and urine microscopy values to identify hematuria cases and to differentiate between gross and microscopic hematuria. Using an iterative process, we refined the ICD-9 algorithm on a gold standard, chart-reviewed cohort of 3,094 hematuria cases, and the ICD-10 algorithm on a 300 patient cohort. We applied the algorithm to Geisinger patients ≥35 years (n = 539,516) and determined performance by conducting chart review (n = 500). RESULTS After applying the hematuria algorithm, we identified 51,500 hematuria cases and 488,016 clean controls. Of the hematuria cases, 11,435 were categorized as gross, 26,658 as microscopic, 12,562 as indeterminate, and 845 were uncategorized. The positive predictive value (PPV) of identifying hematuria cases using the algorithm was 100% and the negative predictive value (NPV) was 99%. The gross hematuria algorithm had a PPV of 100% and NPV of 99%. The microscopic hematuria algorithm had lower PPV of 78% and NPV of 100%. CONCLUSION We developed an algorithm utilizing diagnosis codes and urine laboratory values to accurately identify hematuria and categorize as gross or microscopic in EHRs. Applying the algorithm will help researchers to understand patterns of care for this common condition.
Collapse
Affiliation(s)
- Jasmine Kashkoush
- Department of Urology, Geisinger, Danville, Pennsylvania, United States
| | - Mudit Gupta
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania, United States
| | | | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, United States
| | - Tullika Garg
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, United States
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| |
Collapse
|
11
|
Doshi B, Athans SR, Woloszynska A. Biological differences underlying sex and gender disparities in bladder cancer: current synopsis and future directions. Oncogenesis 2023; 12:44. [PMID: 37666817 PMCID: PMC10477245 DOI: 10.1038/s41389-023-00489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
Sex and gender disparities in bladder cancer have long been a subject of interest to the cancer research community, wherein men have a 4 times higher incidence rate than women, and female patients often present with higher-grade disease and experience worse outcomes. Despite the known differences in disease incidence and clinical outcomes between male and female bladder cancer patients, clinical management remains the same. In this review, we critically analyze studies that report on the biological differences between men and women and evaluate how these differences contribute to sex and gender disparities in bladder cancer. Distinct characteristics of the male and female immune systems, differences in circulating hormone levels and hormone receptor expression, and different genetic and epigenetic alterations are major biological factors that all likely contribute to disparate incidence rates and outcomes for male and female bladder cancer patients. Future preclinical and clinical studies in this area should employ experimental approaches that account for and consider sex and gender disparities in bladder cancer, thereby facilitating the development of precision medicine for the effective treatment of bladder cancer in all patients.
Collapse
Affiliation(s)
- Bhavisha Doshi
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Sarah R Athans
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Anna Woloszynska
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA.
| |
Collapse
|
12
|
Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice. Nat Rev Clin Oncol 2023; 20:287-304. [PMID: 36914746 DOI: 10.1038/s41571-023-00744-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/16/2023]
Abstract
Bladder cancer is among the ten most common cancers globally, causes considerable morbidity and mortality and is, therefore, a substantial burden for health-care systems. The incidence of bladder cancer is affected by demographic trends, most notably population growth and ageing, as well as exposure to risk factors, especially tobacco smoking. Consequently, the incidence has not been stable throughout the world over time, nor will it be in the near future. Further primary prevention efforts are of the utmost importance to reduce the medical and financial burden of bladder cancer on populations and health-care systems. Simultaneously, less-invasive and lower-cost approaches for the diagnosis of both primary and recurrent bladder cancers are required to address challenges posed by the increasing shortage of health-care professionals and limited financial resources worldwide. In this regard, urinary biomarkers have demonstrated promising diagnostic accuracy and efficiency. Awareness of the risk factors and symptoms of bladder cancer should also be increased in society, particularly among health-care professionals and high-risk groups. Studies investigating the associations between lifestyle factors and bladder cancer outcomes are scarce and should be a research priority. In this Review, we outline global trends in bladder cancer incidence and mortality, and discuss the main risk factors influencing bladder cancer occurrence and outcomes. We then discuss the implications, challenges and opportunities of these epidemiological trends for public health and clinical practice.
Collapse
|
13
|
Feminist Emergence in a Traditionally Male Industry: Case from Jordan—The Jordanian Banking Industry. ADMINISTRATIVE SCIENCES 2023. [DOI: 10.3390/admsci13020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose: This research explored the role of female managers as change agents and the “problem of making women visible,” specifically in top management positions in in Jordanian banking industry. Methods: This research design is built on the basis of qualitative research, analyzing the perceptions in the mind of research subjects. Interviews were conducted with 32 participants from the Jordanian banking industry. Findings: Our research has revealed different and important insights into the changing role of Jordanian female workers, not only in such a male-dominant industry but also more broadly in Jordan’s wider society, in which the Arab masculine culture has been dominant. The positive impact of increased acceptance of females’ roles is significantly evident in our research, and we support the assertion that women can survive and prosper in the face of Arab or Eastern culture traditions. In addition, we asserted that females’ managers are deemed to be internal change agents through their knowledge, experience, and leadership traits and behavior. Conclusions: We shed the light on emancipation, in which females have had the opportunity to cross previous social and taken-for-granted boundaries, and which has eroded gender-biased boundaries and behavior as a response to the situational demands.
Collapse
|
14
|
Merone L, Tsey K, Russell D, Nagle C. "I Just Want to Feel Safe Going to a Doctor": Experiences of Female Patients with Chronic Conditions in Australia. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:1016-1028. [PMID: 36636320 PMCID: PMC9811844 DOI: 10.1089/whr.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/29/2022]
Abstract
Background The androcentric history of medicine and medical research has led to an ongoing sex and gender gap in health research and education. Sex and gender gaps in research and education may translate into real-life health inequities for women. This study aimed to explore the experiences of female patients with chronic health conditions in the Australian health system, considering existing sex and gender gaps in medicine. Methods This qualitative study used semistructured in-depth interviews with a sample of adult women with chronic conditions in Australia. Thematic analysis was undertaken, guided by Braun and Clarke. Software NVivoX64 assisted in the management of the data. Coding was performed before grouping into subthemes and central themes. To allow for potential researcher biases, the principal researcher engaged in the practice of reflexivity, including the writing of detailed notes during analysis. Results Twenty adult Australian women with chronic conditions were interviewed. Diagnoses were varied and included Ehlers-Danlos syndrome, chronic fatigue syndrome, functional neurological disorder, and inflammatory bowel disease. Four central themes emerged: diagnostic difficulties; spectrum of health care experiences; understanding medical complexity; and coping with symptoms. Conclusions Women with chronic conditions in Australia report pain, fatigue, and suffering that significantly impacts upon their daily lives. There was a shared experience of feeling that the pain and suffering of women was dismissed or not taken seriously. Many women expressed trauma because of their experiences in health care and often this led to a fear of accessing health services. The participants highlighted a need for more knowledge, understanding, and empathy from health care practitioners.
Collapse
Affiliation(s)
- Lea Merone
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Komla Tsey
- College of Arts, Society, and Education, James Cook University, Cairns, Queensland, Australia
| | - Darren Russell
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| |
Collapse
|
15
|
Min Y, Liu Z, Huang R, Li R, Jin J, Wei Z, He L, Pei Y, Li N, Su Y, Hu X, Peng X. Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study. J Transl Med 2022; 20:560. [PMID: 36463201 PMCID: PMC9719121 DOI: 10.1186/s12967-022-03719-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) severely hindered the timely receipt of health care for patients with cancer, especially female patients. Depression and anxiety were more pronounced in female patients than their male counterparts with cancer during treatment wait-time intervals. Herein, investigating the impact of treatment delays on the survival outcomes of female patients with early-stage cancers can enhance the rational and precise clinical decisions of physicians. METHODS We analyzed five types of cancers in women from the Surveillance, Epidemiology, and End Results (SEER) program between Jan 2010 and Dec 2015. Univariate and multivariate Cox regression analyses were used to determine the impacts of treatment delays on the overall survival (OS) and cancer-specific survival (CSS) of the patients. RESULTS A total of 241,661 females with early-stage cancer were analyzed (12,617 cases of non-small cell lung cancer (NSCLC), 166,051 cases of infiltrating breast cancer, 31,096 cases of differentiated thyroid cancer, 23,550 cases of colorectal cancer, and 8347 cases of cervical cancer). Worse OS rates were observed in patients with treatment delays ≥ 3 months in stage I NSCLC (adjustedHazard ratio (HR) = 1.11, 95% Confidence Interval (CI): 1.01-1.23, p = 0.044) and stage I infiltrating breast cancer (adjustedHR = 1.23, 95% CI 1.11-1.37, p < 0.001). When the treatment delay intervals were analyzed as continuous variables, similar results were observed in patients with stage I NSCLC (adjustedHR = 1.04, 95% CI 1.01-1.06, p = 0.010) and in those with stage I breast cancer (adjustedHR = 1.03, 95% CI 1.00-1.06, p = 0.029). However, treatment delays did not reduce the OS of patients with differentiated thyroid cancer, cervical cancer, or colorectal cancer in the early-stage. Only intermediate treatment delays impaired the CSS of patients with cervical cancer in stage I (adjustedHR = 1.31, 95% CI 1.02-1.68, p = 0.032). CONCLUSION After adjusting for confounders, the prolonged time from diagnosis to the initiation of treatment (< 6 months) showed limited negative effects on the survival of most of the patients with early-stage female cancers. Whether our findings serve as evidence supporting the treatment deferral decisions of clinicians for patients with different cancers in resource-limited situations needs further validation.
Collapse
Affiliation(s)
- Yu Min
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zheran Liu
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Rendong Huang
- grid.506977.a0000 0004 1757 7957School of Nursing, Hangzhou Medical College, Hangzhou, Zhejiang China
| | - Ruidan Li
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Jing Jin
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zhigong Wei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ling He
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Yiyan Pei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ning Li
- grid.410745.30000 0004 1765 1045Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu China
| | - Yongllin Su
- grid.13291.380000 0001 0807 1581Department of Rehabilitation, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xiaolin Hu
- grid.13291.380000 0001 0807 1581West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xingchen Peng
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| |
Collapse
|
16
|
Precision Medicine in the Treatment of Locally Advanced or Metastatic Urothelial Cancer: New Molecular Targets and Pharmacological Therapies. Cancers (Basel) 2022; 14:cancers14205167. [PMID: 36291950 PMCID: PMC9600273 DOI: 10.3390/cancers14205167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Therapeutic breakthroughs in urothelial carcinoma have been occurring rapidly over the past 10 years. However, the resistance and prognosis of this disease is always quite a difficult health challenge. Trying to understand the new therapeutic perspectives is a priority to try to bring in new drug models that can counteract the advancing prognosis and inauspicious diagnosis. Abstract Many variants of urothelial cancer present diagnostic challenges and carry clinical implications that influence prognosis and treatment decisions. The critical issues of treatment-resistant clones are a crucial barrier to care in individuals affected by urothelial carcinoma. Laying the foundations for the resistance evolution, a wide mutational heterogeneity characterizes urothelial carcinoma, noticeable also in patients affected by a early stage disease. In recent years the growing knowledge of the pathogenesis and molecular paths underlying the onset and progression of urothelial cancer are leading to the development of new therapies based on immune checkpoints. Chemotherapy and immunotherapy both operate selectively by shaping the developmental trajectory of urothelial carcinoma in the course of the illness. To date, a promising new therapeutic treatment is represented by antibody-drug conjugates, therapeutic tools that exploit the targeted ability of an antibody to administer cytotoxic drugs directly to the tumor. Indeed, nowadays in the clinical setting there are several treatments available for the treatment of locally advanced or metastatic urothelial cancer, from classic chemotherapeutics such as Gemcitabine, Cisplatin and Carboplatin, Paclitaxel and Docetaxel, to Programmed cell death protein 1 (PD-1) or Programmed death-ligand 1 (PD-L1) inhibitors such as Atezolizumab, Avelumab, Nivolumab, Pembrolizumab, up to anti-nectin 4 Enfortumab Vedotin and Sacituzumab govitecan, which binds Tumor-associated calcium signal transducer 2 (Trop-2) and activates as a topoisomerase inhibitor. The aim of this work is to describe the molecular mechanisms underlying the onset of the urothelial cancer and provide an overview of the immunotherapies that can be used in the clinical setting to counteract it, deepening the efficacy and safety results of the pivotal studies and the place in therapy of these treatments.
Collapse
|
17
|
Gakis G, Weckermann D. [Gender-associated differences in bladder cancer]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:1060-1067. [PMID: 35980439 DOI: 10.1007/s00120-022-01914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Although the incidence of bladder cancer among women is lower, they tend to more often have advanced disease at presentation with a more aggressive course. It is still unclear which factors are responsible for the poorer prognosis of bladder cancer in women. MATERIALS AND METHODS Original papers and reviews from 2004 until 2022 were identified in a PubMed search and evaluated. RESULTS Multiple factors are likely responsible for the different courses of bladder cancer in women versus men. In the literature, epidemiologic and clinical aspects are discussed. Furthermore, genetic and hormonal causes and the role of the urobiome have been the focus of discussion more recently. CONCLUSIONS Earlier diagnosis and better surgical treatment could lead to a more favorable course of bladder cancer in women. Further analyses of genetic, hormonal, und microbiological factors could open new perspectives in the prevention, diagnosis, and treatment of bladder cancer.
Collapse
Affiliation(s)
- Georgios Gakis
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Dorothea Weckermann
- Klinik für Urologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| |
Collapse
|
18
|
Koimtzis G, Alexandrou V, Chalklin CG, Carrington-Windo E, Ramsden M, Karakasis N, Lam KW, Tsakaldimis G. The Role of Adjuvant Single Postoperative Instillation of Gemcitabine for Non-Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051154. [PMID: 35626309 PMCID: PMC9140686 DOI: 10.3390/diagnostics12051154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/05/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
Bladder cancer is a heterogeneous disease with variable natural history. Non-muscle-invasive bladder cancer has a favorable prognosis following transurethral resection, but the optimal adjuvant chemotherapy plan is still in debate. The aim of this study was to evaluate the effect of the adjuvant intravesical administration of a single dose of gemcitabine in the outcome of this disease. For that purpose, we performed a systematic review and meta-analysis on available randomized control trials on MEDLINE, EMBASE, Cochrane, Scopus, and Google Scholar databases. Ultimately, two studies were included with a total number of 654 patients. The statistical analysis performed showed that a single post-operative intravesical dose of gemcitabine does not affect the recurrence rate of non-muscle-invasive bladder cancer compared to placebo. Therefore, this therapeutic strategy does not offer any significant improvement on the outcomes of the disease. Nonetheless, due to the plethora of available therapeutic agents and treatment strategies, further research is needed to establish the optimal treatment in this category of patients.
Collapse
Affiliation(s)
- Georgios Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
- Correspondence: ; Tel.: +44-7716466710
| | - Vyron Alexandrou
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
| | - Christopher G. Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Eliot Carrington-Windo
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Mark Ramsden
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Nikolaos Karakasis
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
| | - Kit W. Lam
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Georgios Tsakaldimis
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
- Department of Medicine, Democritus University of Thrace, Administrative Building, 6th km, 681 00 Alexandroupoli, Greece
| |
Collapse
|
19
|
Howard JM, Nandy K, Woldu SL, Margulis V. Demographic Factors Associated With Non-Guideline-Based Treatment of Kidney Cancer in the United States. JAMA Netw Open 2021; 4:e2112813. [PMID: 34106265 PMCID: PMC8190623 DOI: 10.1001/jamanetworkopen.2021.12813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/06/2021] [Indexed: 01/20/2023] Open
Abstract
Importance Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied. Objective To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. Design, Setting, and Participants This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021. Exposures Demographic factors, including sex, race/ethnicity, and insurance status. Main Outcomes and Measures Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined. Results Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment. Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P < .001) compared with male sex. Compared with White patients, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P < .001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P < .001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01). Individuals who were uninsured, compared with those who had insurance, had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P < .001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001). Conclusions and Relevance This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline-based treatment for women and Black and Hispanic patients. These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account.
Collapse
Affiliation(s)
- Jeffrey M. Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| | - Karabi Nandy
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Solomon L. Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
20
|
Genetic Analysis Reveals Rare Variants in T-Cell Response Gene MR1 Associated with Poor Overall Survival after Urothelial Cancer Diagnosis. Cancers (Basel) 2021; 13:cancers13081864. [PMID: 33919687 PMCID: PMC8069815 DOI: 10.3390/cancers13081864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
Urothelial carcinoma of the bladder (UC) is the fifth most common cancer in the United States. Germline variants, especially rare germline variants, may account for a portion of the disparity seen among patients in terms of UC incidence, presentation, and outcomes. The objectives of this study were to identify rare germline variant associations in UC incidence and to determine its association with clinical outcomes. Using exome sequencing data from the DiscovEHR UC cohort (n = 446), a European-ancestry, North American population, the complex influence of germline variants on known clinical phenotypes were analyzed using dispersion and burden metrics with regression tests. Outcomes measured were derived from the electronic health record (EHR) and included UC incidence, age at diagnosis, and overall survival (OS). Consequently, key rare variant association genes were implicated in MR1 and ADGRL2. The Kaplan-Meier survival analysis reveals that individuals with MR1 germline variants had significantly worse OS than those without any (log-rank p-value = 3.46 × 10-7). Those with ADGRL2 variants were found to be slightly more likely to have UC compared to a matched control cohort (FDR q-value = 0.116). These associations highlight several candidate genes that have the potential to explain clinical disparities in UC and predict UC outcomes.
Collapse
|
21
|
Abufaraj M, Shariat S, Moschini M, Rohrer F, Papantoniou K, Devore E, McGrath M, Zhang X, Markt S, Schernhammer E. The impact of hormones and reproductive factors on the risk of bladder cancer in women: results from the Nurses' Health Study and Nurses' Health Study II. Int J Epidemiol 2021; 49:599-607. [PMID: 31965144 DOI: 10.1093/ije/dyz264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With three out of four new bladder cancer (BCa) cases occurring in men, an apparent gender disparity exists. We aimed to investigate the role of hormonal and reproductive factors in BCa risk using two large female US prospective cohorts. METHODS Our study population comprised 118 256 and 115 383 female registered nurses who were recruited in the Nurses' Health Study (NHS) and NHS II, respectively. Reproductive and hormonal factors and other relevant data were recorded in biennial self-administered questionnaires. Cox-regression analyses were performed to estimate age- and multivariable-adjusted incidence risk ratios (IRRs) and 95% confidence intervals (CIs). Inverse-variance-weighted meta-analysis was used to pool estimates across cohorts. RESULTS During up to 36 years of follow-up, 629 incident BCa cases were confirmed. In the NHS, 22 566 women (21.3%) were postmenopausal at baseline, compared with 2723 women (2.4%) in the NHS II. Among women in the NHS, younger age at menopause (≤45 years) was associated with an increased risk of BCa (IRR: 1.41, 95% CI: 1.11-1.81, Ptrend = 0.01) compared with those with menopause onset at age 50+ years, particularly among ever-smokers (IRR for age at menopause ≤45 years: 1.53, 95% CI: 1.15-2.04; PIntx = 0.16). Age at menarche and first birth, parity, oral-contraceptive use and postmenopausal hormone use were not associated with BCa risk. CONCLUSIONS Overall, we found little support for an association between female reproductive factors and BCa risk in these prospective cohort studies. Earlier age at menopause was associated with a higher risk of BCa, particularly among smokers, indicating the potential for residual confounding.
Collapse
Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Florian Rohrer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kyriaki Papantoniou
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Devore
- Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
22
|
Vo AX, Keeter MK, Tuchman ES, Meeks JJ, Morgans AK. Evaluating Patient-Defined Priorities for Female Patients with Bladder Cancer. Bladder Cancer 2021; 7:53-60. [PMID: 38993211 PMCID: PMC11181836 DOI: 10.3233/blc-200397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although bladder cancer is much more common in men than in women, female patients with bladder cancer present with more locally advanced tumors and have worse disease-specific outcomes than male patients, even after controlling for biological differences. There is a paucity of research regarding the optimal approach to caring for female patients with bladder cancer in ways that maximize patient satisfaction, preferences, and values. OBJECTIVE We sought to explore patient-defined priorities and areas in need of improvement for female patients with bladder cancer from the patient perspective. METHODS We conducted focus group sessions and semi-structured interviews of women treated for bladder cancer to identify patient priorities and concerns until reaching topic saturation. Transcripts were analyzed thematically. RESULTS Eight patients with muscle-invasive bladder cancer and six patients with non-muscle-invasive bladder cancer participated in two focus groups and seven interviews total. Three themes emerged as significantly affecting the care experience: physical impacts, mental health and emotional wellbeing, and the patient-provider interaction. Each theme included patient-defined specific recommendations on approaches to optimizing the care experience for women with bladder cancer. CONCLUSIONS Although most participants were satisfied with the quality of care they received, they identified several opportunities for improvement. These concerns centered around enhancing support for patients' physical and mental needs and strengthening the patient-provider interaction. Efforts to address these needs and reduce gender disparate outcomes via quality improvement initiatives are ongoing.
Collapse
Affiliation(s)
- Amanda X. Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily S. Tuchman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua J. Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alicia K. Morgans
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
23
|
Teoh JYC, Huang J, Ko WYK, Lok V, Choi P, Ng CF, Sengupta S, Mostafid H, Kamat AM, Black PC, Shariat S, Babjuk M, Wong MCS. Global Trends of Bladder Cancer Incidence and Mortality, and Their Associations with Tobacco Use and Gross Domestic Product Per Capita. Eur Urol 2020; 78:893-906. [DOI: 10.1016/j.eururo.2020.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
|
24
|
Viswambaram P, Hayne D. Gender discrepancies in bladder cancer: potential explanations. Expert Rev Anticancer Ther 2020; 20:841-849. [PMID: 32896196 DOI: 10.1080/14737140.2020.1813029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Gender differences in urothelial carcinoma of the bladder (UCB) exist. Although men have a higher incidence of UCB, women tend to have poorer outcomes. We have explored and summarized the evidence for gender differences of UCB diagnosis and prognosis, together with reasons for these disparities. AREAS COVERED The incidence of UCB is 3-4 times higher in men than women. However, women are more likely to be diagnosed with advanced disease. Women have a higher stage-for-stage mortality compared to men, and their greatest risk of death appears to be within the first 2 years of diagnosis. Survival outcomes following radical cystectomy (RC) and radiotherapy are also poorer in women. Delays in diagnosis, differences in female anatomy, as well as poorer surgical outcomes post-RC appear to contribute significantly to the disparities noted between genders. Other factors such as exposure to risk factors, differential hormone signaling, and carcinogen breakdown may also have a role. EXPERT OPINION The gender divide in UCB outcomes has to be addressed. Improved medical and patient education and centralization of RC are recommended.
Collapse
Affiliation(s)
- Pravin Viswambaram
- Urology Research Registrar, Fiona Stanley Hospital; Master of Surgery Student, UWA Medical School, University of Western Australia (UWA) , Australia
| | - Dickon Hayne
- Head of Urology, Fiona Stanley Hospital; Professor of Urology, UWA Medical School, University of Western Australia (UWA); Chair of Bladder Urothelial and Penile Cancer Sub-committee, Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group , Australia
| |
Collapse
|
25
|
Bukavina L, Prunty M, Mishra K, Sun H, Sheyn D, Conroy B, Mahran A, MacLennan G, Schumacher F, Ponsky L, Markt S. Gender Disparities in Bladder Cancer-Specific Survival in High Poverty Areas Utilizing Ohio Cancer Incidence Surveillance System (OCISS). Urology 2020; 151:163-168. [PMID: 32707271 DOI: 10.1016/j.urology.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To better understand the interplay of socioeconomic and demographic traits on bladder cancer outcomes utilizing the Ohio state cancer registry, Ohio Cancer Incidence Surveillance System (OCISS). METHODS We obtained demographic, clinical and outcome data on 47,182 bladder cancer cases diagnosed from 1996 to 2016 from OCISS. Multivariable Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between sex, race and poverty and survival, adjusting age, stage, and primary treatment. RESULTS Within the OCISS database, there were 47,182 patients with a diagnosis of bladder cancer identified, with females representing 12,056 (26%) of the population. There were a total of 9255(35.2%) deaths due to bladder cancer, with median follow-up time of 4.4 years. After adjusting for confounding variables, women were statistically significantly less likely to die from any cause (HR: 0.94, 95% CI: 0.91-0.96), compared with men, but more likely to die from bladder cancer (HR: 1.21, 95% CI: 1.15-1.27). We also found that after adjusting for confounding variables, including sex and poverty, black race was statistically significantly associated with a higher risk of overall (HR: 1.12, 95% CI: 1.06-1.18) and bladder cancer-specific mortality (HR: 1.25, 95% CI: 1.15-1.36). CONCLUSION Using the OCISS database, female gender, self-reported black race, and neighborhood poverty level were associated with worse bladder cancer-specific survival. By recognizing these disparities, we can prospectively address risk factors in efforts to improve survival among these patient populations.
Collapse
Affiliation(s)
- Laura Bukavina
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH.
| | - Megan Prunty
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kirtishri Mishra
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Helen Sun
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH
| | - David Sheyn
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Britt Conroy
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH
| | - Amr Mahran
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH
| | - Gregory MacLennan
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Department of Pathology, Cleveland, OH
| | - Fredrick Schumacher
- Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lee Ponsky
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sarah Markt
- Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| |
Collapse
|
26
|
Mielczarek Ł, Zapała P, Krajewski W, Nowak Ł, Bajkowski M, Szost P, Szabłoński W, Zapała Ł, Poletajew S, Dybowski B, Zdrojowy R, Radziszewski P. Diagnostic and treatment delays among patients with primary bladder cancer in Poland: a survey study. Cent European J Urol 2020; 73:152-159. [PMID: 32782834 PMCID: PMC7407782 DOI: 10.5173/ceju.2020.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study was to determine and quantify the mechanisms responsible for the delays in bladder cancer diagnosis and initial treatment. Material and methods Patients referred to two academic hospitals in Poland with a primary bladder tumor were prospectively identified and structurally interviewed. For all patients, time intervals between symptom onset, diagnostic and therapeutic interventions were assessed. Results A total of 144 patients diagnosed with bladder cancer were included in the analysis. The median time from symptom onset to treatment was 112 days. This comprised of the following median waiting times: 1) patient waiting time of 13 days, 2) assessment waiting time of 14 days and 3) treatment waiting time of 42 days. In the multivariate analysis, large city residence (OR 0.2, 95% CI 0.1-0.6) and comorbidity (OR 0.3, 95% CI 0.1-0.8) reduced the risk of delay, whereas medium-sized city residence (OR 1.4, 95% CI 0.4-5.1) and general practitioner as the first medical professional contact (OR 5.3, 95% CI 0.6-50.0) increased the risk of delay. Conclusions Diagnostic and treatment waiting times for bladder cancer in Poland are unsatisfactory. Potential solutions for shortening these delays include healthcare policy changes such as utilization of the oncological priority programs, primary care education and public health campaigns.
Collapse
Affiliation(s)
- Łukasz Mielczarek
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Łukasz Nowak
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Mateusz Bajkowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Paulina Szost
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Waldemar Szabłoński
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
27
|
Yip W, Cacciamani G, Bhanvadia SK. Disparities in Bladder Cancer Outcomes Based on Key Sociodemographic Characteristics. Curr Urol Rep 2020; 21:24. [PMID: 32377877 DOI: 10.1007/s11934-019-0950-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW A review of the impact of several key patient characteristics on oncologic outcomes in bladder cancer (BC) summarized and analyzed in a narrative fashion. RECENT FINDINGS The bulk of the published literature suggests that females and blacks have poorer cancer-specific outcomes. Both groups tend to present with worse disease, which may be driven by differences in access to timely and quality care. Attempts to assess the association between smoking status and history and BC outcomes have been hindered by the quality and heterogeneity of the data, although several studies have linked smoking with higher rates of recurrence and poorer survival. Being married, particularly in men, may improve survival after radical cystectomy (RC). Limited data suggests that socioeconomic and education levels may be associated with poorer survival; however, the data is limited. A growing body of investigation suggests that there are significant differences in oncologic outcomes in BC patients based on race, gender, smoking status, socioeconomic status, and others. Further focus and investigation is needed to validate these findings, investigate the root cause of these differences, and offer solutions to mitigate them.
Collapse
Affiliation(s)
- Wesley Yip
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Giovanni Cacciamani
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Sumeet K Bhanvadia
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA.
| |
Collapse
|
28
|
Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis. Eur Urol 2020; 77:583-598. [DOI: 10.1016/j.eururo.2019.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
|
29
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the current literature on the impact of gender on oncologic outcomes of bladder cancer (BCa). RECENT FINDINGS Women are more likely to experience disease recurrence, progression, and/or death across all disease states. Furthermore, women are less likely to respond to intravesical therapy for nonmuscle invasive BCa. These disparities are explained by several hypotheses such as differential exposure to environmental carcinogens, hormonal factors, and/or disease management. Additionally, it has been shown that women suffer from delays in diagnosis because of inefficiencies in healthcare delivery. On genomic analyses, women were found to be more likely to harbor basal subtypes of BCa compared with men. SUMMARY A steadily growing body of evidence reveals that women present with more advanced BCa and have stage-for-stage worse outcome compared with men. The underlying mechanisms for this gender difference are multifactorial. Further studies are needed to elucidate the molecular underpinning of this gender-gap and subsequently explore potential novel gender-specific management strategies.
Collapse
|
30
|
Lynch KE, Viernes B, Khader K, DuVall SL, Schroeck FR. Sex and the Diagnostic Pathway to Bladder Cancer among Veterans: No Evidence of Disparity. Womens Health Issues 2019; 30:128-135. [PMID: 31870696 DOI: 10.1016/j.whi.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/04/2019] [Accepted: 11/08/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Longer time intervals from presentation with hematuria to bladder cancer diagnosis have been reported among women compared with men. Despite women being the fastest growing cohort within the Department of Veterans Affairs, little is known about women veterans with bladder cancer. Our objectives were to quantify the time from hematuria to bladder cancer diagnosis in Department of Veterans Affairs and assess differences between sexes. METHODS This was a retrospective cohort study of patients diagnosed with bladder cancer from 2001 to 2016. Included were patients with hematuria for fewer than 365 days before a bladder cancer diagnosis and who had a record of diagnostic cystoscopy after hematuria but before diagnosis. We evaluated the number of days from hematuria to diagnostic cystoscopy (clinical appraisal), cystoscopy to bladder cancer diagnosis (surgical appraisal), and hematuria to bladder cancer diagnosis (total diagnostic appraisal). We used quantile regression models to separately evaluate the effect of sex on the three appraisal intervals. RESULTS Data from 213 women and 24,295 men were analyzed. The median clinical appraisal time was 78 days for women and 72 for men (p = .49). The median surgical appraisal time was 32 days for women and 33 for men (p = .74). The median total diagnostic appraisal time was 135 days for women and 130 for men (p = .71). Multivariable analyses showed no differences between men and women for any of the three appraisal intervals. CONCLUSIONS The majority of time from hematuria to bladder cancer diagnosis is spent in clinical appraisal, but little difference was observed between men and women in Department of Veterans Affairs.
Collapse
Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
| | - Benjamin Viernes
- VA Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Karim Khader
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah; IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Florian R Schroeck
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire; White River Junction VA Medical Center, White River Junction, Vermont; Section of Urology and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
31
|
Abstract
Men are at a higher risk of developing bladder cancer, but women present with more advanced disease and have more unfavourable outcomes. Although epidemiologic and genetical studies have underlined the multifactorial aetiology and gender-related differences of bladder cancer, there is lack of evidence-based recommendation for gender-specific management of bladder cancer. We summarize the evidence and most recent findings on gender-specific differences in bladder cancer incidence, diagnosis, treatment and outcome, spotlighting the gender disparities in genetic and hormonal risk factors, pelvic anatomy, diagnostic setting and surgical choices. We reviewed the literature published on PubMed between 1981 and 2018. Males have a threefold to fourfold higher risk of bladder cancer as compared to females; however, women have higher stage-for-stage mortality, being diagnosed with more advanced disease, mostly due to a delay in haematuria evaluation. Numerous studies indicate an increased risk of disease recurrence or progression in women with non-muscle-invasive bladder cancer treated with trans-urethral resection, with or without intravesical chemotherapy or immunotherapy, compared to males. In particular, recent molecular evidence show that there is an excess of female Ta mutant tumours. At the time of radical cystectomy, women have a significantly longer length of hospital stay, operative time, higher blood loss and higher 90-day mortality and perioperative complication rate. Moreover, females are less likely to receive a continent diversion. Future research should guarantee greater inclusion of women in trials and focus on improving the effectiveness of therapies in women, perhaps exploring different therapeutic approaches in men and women. Specific data on functional and oncological outcomes can be analysed to define predictive factors able to guide the surgeon in decisions based on evidence. It is urgently needed to limit gender-related discrepancies in early diagnosis and treatment of bladder cancer. Public awareness and bladder cancer female patients' consciousness on gender inequalities must be similarly uprisen.
Collapse
Affiliation(s)
- Mariangela Mancini
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences and School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Marialaura Righetto
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences and School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Giovannella Baggio
- Department of Medicine (DIMED) and School of Medicine and Surgery, University of Padova, Padova, Italy
| |
Collapse
|
32
|
Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
Collapse
Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
| |
Collapse
|
33
|
Sloan FA, Yashkin AP, Akushevich I, Inman BA. Longitudinal patterns of cost and utilization of medicare beneficiaries with bladder cancer. Urol Oncol 2019; 38:39.e11-39.e19. [PMID: 31761612 DOI: 10.1016/j.urolonc.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/17/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bladder cancer (BC) is highly prevalent and costly. This study documented cost and use of services for BC care and for other (non-BC) care received over a 15-year follow-up period by a cohort of Medicare beneficiaries diagnosed with BC in 1998. METHODS Data came from the Surveillance, Epidemiology and End Results Program linked to Medicare claims. Medicare claims provided data on diagnoses, services provided, and Medicare Parts A and B payments. Cost was actual Medicare payments to providers inflated to 2018 US$. Cost and utilization were BC-related if the claim contained a BC diagnosis code. Otherwise, costs were for "other care." For utilization, we grouped Part B-covered services into 6 mutually-exclusive categories. Utilization rates were ratios of the count of claims in a particular category during a follow-up year divided by the number of beneficiaries with BC surviving to year-end. RESULTS Cumulatively over 15-years, for all stages combined, total BC-related cost per BC beneficiary was $42,011 (95% Confidence Interval (CI): $42,405-$43,417); other care cost was about twice this number. Cumulative total BC-related cost of 15-year BC survivors for all stages was $43,770 (CI: $39,068-$48,522), intensity of BC-related care was highest during the first year following BC diagnosis, falling substantially thereafter. After follow-up year 5, there were few statistically significant changes in BC-related utilization. Utilization of other care remained constant during follow-up or increased. CONCLUSIONS Substantial costs were incurred for non-BC care. While increasing BC survivorship is an important objective, non-BC care would remain a burden to Medicare.
Collapse
Affiliation(s)
- Frank A Sloan
- Department of Economics, Duke University, Durham, NC
| | - Arseniy P Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC.
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC
| | - Brant A Inman
- Department of Surgery, Urology Division, Duke Medical Center, Durham, NC
| |
Collapse
|
34
|
Zhou Y, van Melle M, Singh H, Hamilton W, Lyratzopoulos G, Walter FM. Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. BMJ Open 2019; 9:e029143. [PMID: 31585970 PMCID: PMC6797416 DOI: 10.1136/bmjopen-2019-029143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute. DESIGN We performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer. DATA SOURCES We searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019. ELIGIBLE CRITERIA We focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed. RESULTS 28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis. CONCLUSIONS Women, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers.
Collapse
Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Georgios Lyratzopoulos
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
35
|
Sell V, Ettala O, Montoya Perez I, Järvinen R, Pekkarinen T, Vaarala M, Seppänen M, Liukkonen T, Marttila T, Aaltomaa S, Kaasinen E, Boström PJ. Symptoms and diagnostic delays in bladder cancer with high risk of recurrence: results from a prospective FinnBladder 9 trial. World J Urol 2019; 38:1001-1007. [PMID: 31177305 PMCID: PMC7154016 DOI: 10.1007/s00345-019-02841-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose To investigate the symptoms and delays in the clinical pathway of bladder cancer (BC). Methods This is a substudy of a prospective, randomized, multicenter phase III study (FinnBladder 9, NCT01675219) where the efficacy of photodynamic diagnosis and 6 weekly optimized mitomycin C instillations are studied in pTa bladder cancer with high risk for recurrence. The data of presenting symptoms and critical time points were prospectively collected, and the effect of factors on delays was analyzed. Results At the time of analysis, 245 patients were randomized. Analysis included 131 patients with primary bladder cancer and their complete data. Sixty-nine percent had smoking history and 67% presented with macroscopic hematuria. Median patient delay (from symptoms to health-care contact) was 7 days. The median general practice delay (from health-care contact to urology referral) was 8 days. Median time from urology referral to cystoscopy was 23 days and from cystoscopy to TUR-BT 21 days. Total time used in the clinical pathway (from symptom to TUR-BT) was 78 days. Current and former smokers had non-significantly shorter patient-related and general practice delays compared to never smokers. TUR-BT delay was significantly shorter in patients with malignant cytology (16 days) compared to patients with benign cytology (21 days, p = 0.03). Conclusions Patient-derived delay was short and most of the delay occurred in the referral centers. The majority had macroscopic hematuria as the initial symptom. Surprisingly, current and past smokers were more prone to contact the health-care system compared to never smokers.
Collapse
Affiliation(s)
- Ville Sell
- Department of Urology, Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | | | - Riikka Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tarmo Pekkarinen
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Markku Vaarala
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Tapani Liukkonen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - Timo Marttila
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Eero Kaasinen
- Department of Surgery, Hospital of Hyvinkää, Hyvinkää, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| |
Collapse
|
36
|
Abstract
OBJECTIVES The objectives of this were to determine the correlation of greater than or equal to 3 red blood cells per high-power field (RBCs/HPF) with a positive urine dipstick for blood and to identify clinically relevant factors than can influence this relationship. METHODS The charts of women with positive blood urine dipsticks were reviewed from August 2012 to August 2013. The cohort of women was divided into 2 groups; those with urine with greater than or equal to 3 RBCs/HPF on microscopy and those without. Relevant clinical and demographic variables were extracted from the electronic medical record. Data analysis was conducted using SAS version 9.4 (SAS Institute, Cary, NC). RESULTS Most of the 203 patients eligible for analysis were Caucasian, and the total cohort had a mean age of approximately 62.8 years. Microscopy confirmed greater than or equal to 3 RBCs/HPF in 25.6% of the urine samples. A dipstick finding of moderate or large blood was significantly more likely to have greater than or equal to 3 RBCs/HPF on univariate and multivariable analyses (P < 0.001). Factors significantly associated with greater than or equal to 3 RBCs/HPF were increasing age, recurrent urinary tract infections, and urinary specific gravity of greater than 1.010. CONCLUSIONS Lower urinary specific gravities appear to be associated with underestimating microhematuria, likely owing to the underrepresentation of the true number of red blood cells. Urine dipstick indicators of moderate or large blood increase the likelihood the microscopy samples demonstrated greater than or equal to 3 RBCs/HPF. These findings suggest that clarification of microhematuria detection and evaluation guidelines should be considered, given both important clinical and economic consequences.
Collapse
|
37
|
Urologic oncology workforce diversity: A first step in reducing cancer disparities. Urol Oncol 2019; 40:120-125. [PMID: 31104976 DOI: 10.1016/j.urolonc.2019.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 04/21/2019] [Indexed: 11/21/2022]
Abstract
Urologic cancer disparities based on race/ethnicity and gender are well-documented across the cancer continuum. Patients cared for by physicians of similar race/ethnicity and gender report better communication, patient satisfaction, and care adherence which has the potential to translate into better health outcomes. We believe that ensuring a diverse Urologic Oncology workforce is an important first step toward eliminating cancer disparities due to the downstream effects of improved communication between concordant patient-physician dyads. In this essay, we review the demographics of the Urologic cancer patient population and Urologic Oncology workforce; describe current evidence supporting healthcare workforce diversity, especially related to race and gender-based concordant patient-physician relationships; and make recommendations for individual and institutional strategies to develop and support a diverse workforce in Urologic Oncology.
Collapse
|
38
|
Bukavina L, Mishra K, Mahran A, Shekar A, Sheyn D, Slopnick E, Hijaz A, Jankowski J, Ponsky L, Nguyen C. Gender Disparity in Cystectomy Postoperative Outcomes: Propensity Score Analysis of the National Surgical Quality Improvement Program Database. Eur Urol Oncol 2019; 4:84-92. [PMID: 31368436 DOI: 10.1016/j.euo.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/18/2019] [Accepted: 04/04/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND While female gender is considered a protective determinant in the majority of cancers, outcomes in women diagnosed with bladder cancer have continued to show disproportional mortality when compared with men. OBJECTIVE The aim of this retrospective propensity score-matched analysis was to evaluate the intra- and postoperative differences among genders, as well as to evaluate reproductive organ-preserving radical cystectomy (ROPRC) as compared with radical cystectomy (RC) as a potential confounder in female cystectomy patients. DESIGN, SETTING, AND PARTICIPANTS Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), men and women undergoing a cystectomy between 2011 and 2017 were analyzed. In addition, females undergoing ROPRC and RC were analyzed for immediate postoperative outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Men and women undergoing a cystectomy were evaluated through propensity score matching (PSM) for baseline differences using a 1:1 caliper width of 0.2 to the nearest neighbor. Using multivariable logistic regression analysis, we evaluated differences in the risk of readmission, complications, and reoperation in the immediate postsurgical period in males and females. Similarly, differences were assessed in ROPRC and RC groups. RESULTS AND LIMITATIONS We achieved a balance between males and females after PSM: 1263 males and 1263 females treated with cystectomy. The risks of readmission (adjusted odds ratio [aOR] 1.228 [1.005-1.510], p=0.045), superficial surgical site infection (aOR 1.507 [1.095-2.086], p=0.012), and transfusion (aOR 2.031 [1.713-2.411], p<0.001) were increased in females undergoing a cystectomy compared with males. No differences were observed in surgical outcomes in ovarian sparing/RC cohort. CONCLUSIONS Using the 2011-2017 NSQIP database, we were able to demonstrate an increased rate of postoperative transfusion, readmission rate, and surgical site infection in females who underwent cystectomy. Our findings suggest that females experience an increased rate of complications in the immediate postoperative period. This may ultimately lead to worse oncologic outcomes in females after an RC. Lastly, we did not find any increased rate of complications in ROPRC as compared with RC. PATIENT SUMMARY This study highlights differences in immediate postoperative outcomes between males and females undergoing cystectomy for bladder cancer. Some of these potential differences include higher risk of infection, transfusion, and readmission. These differences may predispose females to worse long-term outcomes. In addition, due to potential benefits of ovarian preservation in the recent literature, we also evaluated the risks and complications of ovarian sparing cystectomy. We found ovarian preservation to be a safe and feasible procedure in a highly selected group of patients.
Collapse
Affiliation(s)
- Laura Bukavina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Metro Health Medical Center, Cleveland, OH, USA
| | - Kirtishri Mishra
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Metro Health Medical Center, Cleveland, OH, USA
| | - Amr Mahran
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA
| | - Anjali Shekar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA
| | - David Sheyn
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Metro Health Medical Center, Cleveland, OH, USA
| | - Emily Slopnick
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Metro Health Medical Center, Cleveland, OH, USA
| | - Adoniz Hijaz
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA
| | - Jason Jankowski
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lee Ponsky
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Carvell Nguyen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Metro Health Medical Center, Cleveland, OH, USA.
| |
Collapse
|
39
|
Nakayama M, Ito Y, Hatano K, Nakai Y, Kakimoto KI, Miyashiro I, Nishimura K. Impact of sex difference on survival of bladder cancer: A population-based registry data in Japan. Int J Urol 2019; 26:649-654. [PMID: 30916420 DOI: 10.1111/iju.13955] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/03/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the impact of sex on the prognosis of bladder cancer in Japan. METHODS In total, 18 728 patients diagnosed as having bladder cancer from 1993 to 2006 were registered in population-based cancer registries of six prefectures in Japan. We estimated relative survival by sex, age, clinical stage at initial diagnosis and pathology. RESULTS Patients included 14 203 men (75.8%) and 4525 women (24.2%). The stage at initial diagnosis in women was significantly higher than in men (P < 0.0001). Pathologically, women were more likely to have non-urothelial cancer than men (women 18.0%, men 9.5%, P < 0.0001). The 5-year relative survival was 80.3% for men and 67.7% for women. The 5-year relative survival was 93.0% for men and 87.7% for women in the localized cancer group, 34.8% for men and 23.9% for women in the locally advanced cancer group, and 7.1% for men and 8.3% for women in the metastatic cancer group. The relative survival of women was worse than that of men in the localized cancer group (hazard ratio 1.29, 95% confidence interval 1.05-1.57; P = 0.0145) and locally advanced cancer group (hazard ratio 1.32, 95% confidence interval 1.15-1.52; P = 0.0001), but not different in the metastatic cancer group (hazard ratio 1.04, 95% confidence interval 0.87-1.25; P = 0.6555). CONCLUSIONS Population-based registry data in Japan show that the cancer stage at initial diagnosis is higher in women than in men, and women with localized or locally advanced bladder cancer have a worse prognosis compared with men.
Collapse
Affiliation(s)
- Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical College, Osaka, Japan.,Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
40
|
Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy. Urol Oncol 2019; 37:300.e1-300.e7. [PMID: 30661870 DOI: 10.1016/j.urolonc.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/28/2018] [Accepted: 01/05/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Disparities in survival for bladder and kidney cancer among the genders and patients with varying insurance coverage have been identified. Microhematuria (MH), a potential early clinical sign of genitourinary malignancy, should prompt a standardized diagnostic evaluation. However, many patients do not complete a full evaluation and may be at risk of a missed or delayed identification of genitourinary pathology. METHODS Patients 35 and older with a new diagnosis of MH between 2007 and 2015 were retrospectively identified at a large health system. Our primary outcome of interest was completion of cystoscopy and imaging. Regression modeling was used to assess associations between gender and insurance status with completion of a MH evaluation, adjusted for clinical factors, urinalysis data, and patient demographics. RESULTS Of 15,161 patients with MH, only 1,273 patients (8.4%) completed upper tract imaging and a cystoscopy; 899 (5.9%) within 1 year. Median time to imaging was 75days and 68.5days for cystoscopy. Of those with an incomplete evaluation, 23.7% underwent cystoscopy and 76.3% underwent imaging. Male gender, private insurance, and increased MH severity on UA were associated with a complete evaluation. More patients who completed an evaluation were diagnosed with bladder (4.8% vs. 0.3%) and kidney cancer (3.1% vs. 0.4%) when compared to those who did not. CONCLUSION Few patients complete a timely evaluation of MH. Women and underinsured patients are disproportionately less likely to complete a work-up for microhematuria and this may have downstream implications for diagnosis.
Collapse
|
41
|
Han DS, Zhou W, Seigne JD, Lynch KE, Schroeck FR. Geographic Variation in Cystoscopy Rates for Suspected Bladder Cancer between Female and Male Medicare Beneficiaries. Urology 2018; 122:83-88. [PMID: 30138684 PMCID: PMC6295281 DOI: 10.1016/j.urology.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess geographic variation in cystoscopy rates among women vs men with suspected bladder cancer, lending insight into gender-specific differences in cystoscopic evaluation. METHODS We conducted a cross-sectional study of all fee-for-service Medicare beneficiaries within 306 Hospital Referral Regions (HRRs) who received care in 2014. For each HRR, we calculated the age- and race-adjusted cystoscopy rate for women and men as our primary outcome. The rate was the number of beneficiaries who underwent cystoscopy for bladder cancer symptoms (using procedure and ICD-9 diagnosis codes) divided by all beneficiaries in the HRR. We used the coefficient of variation to compare relative variability of cystoscopy rates. RESULTS Overall, 173,551 women (n = 14.8 million) and 286,090 men (n = 11.5 million) underwent cystoscopy in 2014. While women received less cystoscopies compared to men (mean 11.0 vs 23.5 per 1000, P < .001), there was greater variation in cystoscopy rates among women (coefficient of variation 27.5 vs 23.5, P = .010). When restricting to ICD-9 codes for hematuria only, women continued to demonstrate greater variation in cystoscopy rates (coefficient of variation 27.8 vs 24.2, P = .022). Findings were robust across larger HRR sizes-thereby removing some random variation seen in smaller HRRs-as well as across years 2010, 2011, 2012, and 2013. CONCLUSION Cystoscopy rates are lower in women than men, likely due to their lower bladder cancer incidence. However, there is greater variation in cystoscopy rates among women with symptoms of bladder cancer. This may reflect increased provider uncertainty whether to refer and work-up women with suspected bladder cancer.
Collapse
Affiliation(s)
- David S. Han
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Weiping Zhou
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - John D. Seigne
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System and the Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Florian R. Schroeck
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The White River Junction VA Medical Center, White River Junction, VT
| |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW Bladder cancer (BC) is the second most common genitourinary malignancy, with a growing population of survivors globally. Over the past two decades, there has been a growing awareness of not only the oncologic, but also the quality of life ramifications of a BC diagnosis, treatment, and surveillance. In the current review, the literature surrounding the many domains that encompass bladder cancer survivorship is summarized and analyzed. RECENT FINDINGS There have been ongoing efforts to decrease perioperative morbidity, particularly in patients undergoing radical cystectomy, with mixed results. There is a growing emphasis on the short and long-term health-related quality of life (HR-QoL) impacts of bladder cancer spanning the domains of physical and mental QoL related to urinary function, sexual function, and financial and psychological burden, with validated measures specific to BC patients. There continue to be disparities in oncologic outcomes by race and gender. The impact of BC is prolonged and there is an unmet need for long term support and survivorship resources to address this. There is a growing global population of bladder cancer patients, and their needs are complex and vary by stage, treatment, and certain demographic features. Outcome-centered perioperative strategies show potential to diminish treatment morbidity, and validated BC specific HR-QoL tools have helped to define the impact and burden of BC, but there continue to be large areas of unmet need that warrant greater study and intervention.
Collapse
Affiliation(s)
- Sumeet K Bhanvadia
- USC/Norris Comprehensive Cancer Center, Keck School of Medicine, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90094, USA.
| |
Collapse
|
43
|
Meeks JJ, Glaser AP. Editorial Comment. J Urol 2018; 200:60. [PMID: 29679580 DOI: 10.1016/j.juro.2017.11.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Joshua J Meeks
- Department of Urology, Northwestern University, Chicago, Illinois
| | | |
Collapse
|
44
|
Sjöström C, Thorstenson A, Ströck V, Hosseini-Aliabad A, Aljabery F, Liedberg F, Sherif A, Malmström PU, Rosell J, Gårdmark T, Jahnson S. Treatment according to guidelines may bridge the gender gap in outcome for patients with stage T1 urinary bladder cancer. Scand J Urol 2018; 52:186-193. [PMID: 29676191 DOI: 10.1080/21681805.2018.1462254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this investigation was to study differences between male and female patients with stage T1 urinary bladder cancer (UBC) regarding intravesical instillation therapy, second resection and survival. MATERIALS AND METHODS This study included all patients with non-metastatic primary T1 UBC reported to the Swedish National Register of Urinary Bladder Cancer (SNRUBC) from 1997 to 2014, excluding those treated with primary cystectomy. Differences between groups were evaluated using chi-squared tests and logistic regression, and survival was investigated using Kaplan-Meier and log-rank tests and Cox proportional hazards analysis. RESULTS In all, 7681 patients with T1 UBC (77% male, 23% female) were included. Females were older than males at the time of diagnosis (median age at presentation 76 and 74 years, respectively; p < .001). A larger proportion of males than females underwent intravesical instillation therapy (39% vs 33%, p < .001). Relative survival was lower in women aged ≥75 years and women with G3 tumours compared to men. However, women aged ≥75 years who had T1G3 tumours and underwent second resection followed by intravesical instillation therapy showed a relative survival equal to that observed in men. CONCLUSIONS This population-based study demonstrates that women of all ages with T1 UBC undergo intravesical instillation therapy less frequently than men, and that relative survival is poorer in women aged ≥75 years than in men of the same age when intravesical instillation therapy and second resection are not used. However, these disparities may disappear with treatment according to guidelines.
Collapse
Affiliation(s)
- Carin Sjöström
- a Section of Urology, Department of Surgery , Capio S:t Göran's Hospital , Stockholm , Sweden.,b Department of Molecular Medicine and Surgery , Section of Urology, Karolinska Institute , Stockholm , Sweden
| | - Andreas Thorstenson
- a Section of Urology, Department of Surgery , Capio S:t Göran's Hospital , Stockholm , Sweden.,b Department of Molecular Medicine and Surgery , Section of Urology, Karolinska Institute , Stockholm , Sweden
| | - Viveka Ströck
- c Department of Urology , Sahlgrenska University Hospital , Göteborg , Sweden
| | | | - Firas Aljabery
- e Department of Urology , University Hospital and IKE, Linköping University , Linköping , Sweden
| | - Fredrik Liedberg
- f Department of Translational Medicine , Lund University , Malmö , Sweden.,g Department of Urology , Skåne University Hospital , Malmö , Sweden
| | - Amir Sherif
- h Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden
| | - Per-Uno Malmström
- i Department of Urology , Akademiska University Hospital , Uppsala , Sweden
| | - Johan Rosell
- j Regional Cancer Center South East Sweden and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Truls Gårdmark
- k Section of Urology, Department of Surgery , Danderyd's Hospital , Stockholm , Sweden.,l Department of Clinical Sciences Danderyd's Hospital , Karolinska Institute , Stockholm , Sweden
| | - Staffan Jahnson
- e Department of Urology , University Hospital and IKE, Linköping University , Linköping , Sweden
| |
Collapse
|
45
|
Lough T, Luo Q, Luxmanan C, Anderson A, Suttie J, O'Sullivan P, Darling D. Clinical utility of a non-invasive urine test for risk assessing patients with no obvious benign cause of hematuria: a physician-patient real world data analysis. BMC Urol 2018. [PMID: 29523118 PMCID: PMC5845194 DOI: 10.1186/s12894-018-0327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The non-invasive Cxbladder urine test system has demonstrated clinical utility in ruling out urothelial carcinoma (UC) in patients with asymptomatic microscopic hematuria (AMH), suggesting that the number of invasive diagnostic tests, including cystoscopy, used in this patient population may be reduced by Cxbladder testing prior to conducting a full urological work-up. The aim of this study was to demonstrate the enhanced clinical utility of communicating objective information on diagnostic decisions made by individual physicians on individual patients with AMH. Methods Three hundred ninety-six physician-patient decisions were generated from twelve participant physicians evaluating real world case notes from the same 33 patients presenting with AMH. Each physician reviewed and recommended diagnostic tests and procedures based on each patient’s referral data and then re-evaluated their clinical recommendation following disclosure of the non-invasive Cxbladder urine test result. Changes assessed were the total number of requested diagnostic procedures and the number of invasive procedures, including cystoscopy, following addition of information from Cxbladder in the Triage and Triage and Detect modalities. Results Physicians made significant changes to their diagnostic behavior for patients with AMH when presented with Cxbladder test results, including a reduction in the number of total and invasive procedures including cystoscopy for individuals identified as having a low probability of UC. The intensity of investigation was targeted and increased, including use of total procedures and cystoscopy, for patients identified by Cxbladder tests as having a high probability of UC: urologists increased the level of investigation for both total procedures and invasive procedures. The outcome resulted in patients with a high risk of UC receiving appropriate guideline-recommended invasive diagnostic tests. Patients who tested negative were offered fewer and significantly less invasive procedures. This change in physician behavior results in an increased clinical and patient utility, lower risk of missed UC and invasive test-related harm incidents. Conclusions This study demonstrated the potential for increased clinical resolution and significantly enhanced patient management, when physicians consider Cxbladder test results in their clinical evaluation. The change in physician behavior led to more appropriate diagnostic procedure selection and resource allocation to the benefit of both patients and healthcare systems. Electronic supplementary material The online version of this article (10.1186/s12894-018-0327-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tony Lough
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Qingyang Luo
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Carthika Luxmanan
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.,University of Otago, Dunedin, New Zealand
| | - Alastair Anderson
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Jimmy Suttie
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.
| | - Paul O'Sullivan
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.,Merck, Sharpe & Dohme, Auckland, New Zealand
| | - David Darling
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| |
Collapse
|
46
|
Zychlinsky Scharff A, Albert ML, Ingersoll MA. Urinary Tract Infection in a Small Animal Model: Transurethral Catheterization of Male and Female Mice. J Vis Exp 2017. [PMID: 29286380 DOI: 10.3791/54432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Urinary tract infections (UTI) are extremely common worldwide, incurring significant morbidity and healthcare-associated expenses. Small animal models, which accurately reflect disease establishment and progression, permit dissection of host-pathogen interactions and generation of immunity to infection. In mice, intravesical instillation of uropathogenic E. coli, the causative agent in more than 85% of community acquired UTI, recapitulates many of the stages of infection observed in humans. Until recently, however, UTI could only be modeled in female animals. This limitation has hindered the study of sex-related differences in UTI, as well as other bladder pathologies, such as cancer. Here, we describe a method to instill male mice that allows direct comparison between female and male animals and provide a detailed protocol to assess bladder tissue by flow cytometry as a means to better understand host responses to infection. Together, these approaches will aid in the identification of host factors that contribute to sex biases observed in UTI and other bladder-associated diseases.
Collapse
Affiliation(s)
- Anna Zychlinsky Scharff
- Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, INSERM U818
| | - Matthew L Albert
- Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, INSERM U818; Genentech
| | - Molly A Ingersoll
- Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, INSERM U818;
| |
Collapse
|
47
|
Richards KA, Ruiz VL, Murphy DR, Downs TM, Abel EJ, Jarrard DF, Singh H. Diagnostic evaluation of patients presenting with hematuria: An electronic health record-based study. Urol Oncol 2017; 36:88.e19-88.e25. [PMID: 29169843 DOI: 10.1016/j.urolonc.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/04/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To gain new insights into the origin and prevention of diagnostic delays in the evaluation of hematuria in an electronic health record (EHR)-based integrated care setting. METHODS We performed a retrospective review of 298 consecutive patients with new-onset hematuria at a Veterans Affairs facility from January 1, 2011 to December 31, 2013 excluding those where diagnostic evaluation was unnecessary (i.e., cystoscopy within 3 years prior). We collected data on presentation, such as red flags of painless gross hematuria (PGH) or asymptomatic microhematuria (AMH) and subsequent evaluation (imaging, urologic referral, and cystoscopy). Delay was defined when evaluation was not completed within 60 days. Logistic regression was performed to identify predictors of delay. RESULTS Of 201 patients, 149 had delays. PGH was present in 99 patients. These patients had a higher rate of urology referral within 1 year than patients with AMH (86.7% vs. 64.7%; P<0.01) and were more likely to undergo cystoscopy (75.8% vs. 52%; P<0.01). Delays occurred in 67% of PGH patients vs. 81% of AMH patients (OR 0.46; P = 0.02), and roughly a third were related to scheduling/coordination, patient-related issues, or delay in primary care referral. Bladder neoplasms were detected in 18% of patients with PGH and 2% of those with AMH. CONCLUSION Delays in evaluation for hematuria occur commonly, regardless of strength of the red-flag. Many delays were preventable and could be targeted with interventions including EHR-based tracking systems or reformed scheduling practices.
Collapse
Affiliation(s)
- Kyle A Richards
- Department of Surgery, William S. Middleton Memorial Veterans Hospital, Section of Urology, Madison, WI; Department of Urology, The University of Wisconsin-Madison, Madison, WI.
| | - Vania Lopez Ruiz
- Department of Urology, The University of Wisconsin-Madison, Madison, WI
| | - Daniel R Murphy
- Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Tracy M Downs
- Department of Urology, The University of Wisconsin-Madison, Madison, WI
| | - E Jason Abel
- Department of Urology, The University of Wisconsin-Madison, Madison, WI
| | - David F Jarrard
- Department of Urology, The University of Wisconsin-Madison, Madison, WI
| | - Hardeep Singh
- Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| |
Collapse
|
48
|
McCombie SP, Bangash HK, Kuan M, Thyer I, Lee F, Hayne D. Delays in the diagnosis and initial treatment of bladder cancer in Western Australia. BJU Int 2017; 120 Suppl 3:28-34. [DOI: 10.1111/bju.13939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Melvyn Kuan
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Isaac Thyer
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Fran Lee
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Dickon Hayne
- Fiona Stanley Hospital; Murdoch WA Australia
- University of Western Australia; Perth WA Australia
| |
Collapse
|
49
|
Ngo B, Perera M, Papa N, Bolton D, Sengupta S. Factors affecting the timeliness and adequacy of haematuria assessment in bladder cancer: a systematic review. BJU Int 2017; 119 Suppl 5:10-18. [DOI: 10.1111/bju.13821] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Ngo
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Nathan Papa
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Damien Bolton
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Shomik Sengupta
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| |
Collapse
|
50
|
Ngo B, Papa N, Perera M, Bolton D, Sengupta S. Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria. BJU Int 2017; 119 Suppl 5:19-25. [DOI: 10.1111/bju.13809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Brian Ngo
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Nathan Papa
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Damien Bolton
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Shomik Sengupta
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| |
Collapse
|