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McCully M, Lipkis J, Heller A, Huñis A. Challenges and opportunities in NMIBC management across Latin America: insights from healthcare providers and a patient advocacy group. Ecancermedicalscience 2024; 18:1711. [PMID: 39021547 PMCID: PMC11254412 DOI: 10.3332/ecancer.2024.1711] [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: 05/07/2024] [Indexed: 07/20/2024] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) is characterised by high rates of recurrence and progression, requiring substantial healthcare resources. In Latin America, the incidence of NMIBC is set to increase due to an aging population and lifestyle changes. To better understand the current challenges for NMIBC treaters and patients, a mixed-methods approach was leveraged combining secondary research with qualitative interviews from healthcare providers in Brazil, Colombia, Mexico and Argentina. Our analysis found that significant challenges persist across the region, particularly due to Bacillus Calmette-Guérin shortages, inconsistent adherence to clinical guidelines and significant socioeconomic disparities for patients accessing healthcare services. Addressing these challenges requires improved patient advocacy, strategic use of clinical trials and better resource distribution to enhance NMIBC management across Latin America.
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Affiliation(s)
- Mark McCully
- PharmaValue Partners, 603 Mattison Avenue, Suite 319, Asbury Park, NJ 07712, USA
| | - Julia Lipkis
- PharmaValue Partners, 603 Mattison Avenue, Suite 319, Asbury Park, NJ 07712, USA
| | - Aryel Heller
- PharmaValue Partners, 603 Mattison Avenue, Suite 319, Asbury Park, NJ 07712, USA
| | - Adrian Huñis
- A. Hunis & Associates, Oncology Consultants, Hollywood, FL 33019, USA
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Awad M, Harraz AM, Farg H, Gabr HS, Sharaf DE, Abou-El-Ghar M, El-Hefnawy AS, Osman Y. Microscopic hematuria and pelvic ultrasonography could rule out flexible cystoscopy during surveillance for T1-low grade non-muscle invasive bladder cancer. Arab J Urol 2023; 21:150-155. [PMID: 37521447 PMCID: PMC10373612 DOI: 10.1080/2090598x.2023.2202930] [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: 02/01/2023] [Accepted: 04/09/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Cystoscopy (rigid/flexible [FC]) is the standard surveillance tool for non-muscle invasive bladder cancer (NMIBC). Nevertheless, it has its drawbacks. The objective of this study is to evaluate the performance of microscopic hematuria (MH), abdominal ultrasonography (US), and urine cytology (UC) as potential substitutes for FC in patients with T1-low-grade (T1-LG) NMIBC. Methods Over a 12-month period, patients attending our tertiary referral center for T1-LG NMIBC follow-up underwent urine analysis for MH and UC, and then US and FC were performed as outpatient surveillance procedures. Those with positive findings underwent inpatient rigid cystoscopy under anesthesia and biopsy. The negative predictive values (NPV) and sensitivity of different combinations of MH, UC, US, and FC were compared with the standard histopathology. Results In 218 evaluated patients, FC had the highest NPV (97.9%). However, this figure showed no statistically significant difference if compared with the combination of negative MH and US (93.8%) (difference = 0.04, p = 0.1) or the combination of MH, US, and UC (94.9%) (difference = 0.03, p = 0.2). The reported sensitivity results were similarly comparable between FC (94.2%) and the aforementioned combinations (90.4% and 92.3%; differences: 0.038 and 0.019; p = 0.4 and 0.7, respectively). Conclusions During the surveillance of NMIBC for patients diagnosed with T1-LG disease, the combination of MH/US has comparable sensitivity and NPV with FC. This non-invasive combination could be considered the first station that might preclude the need for FC in a considerable percentage of this group of patients.
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Affiliation(s)
- Mohamed Awad
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Harraz
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hashim Farg
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hady S. Gabr
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Doaa E. Sharaf
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | | | | | - Yasser Osman
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
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Nicola R, Pecoraro M, Lucciola S, Dos Reis RB, Narumi Y, Panebianco V, Muglia VF. VI-RADS score system - A primer for urologists. Int Braz J Urol 2022; 48:609-622. [PMID: 35195385 PMCID: PMC9306377 DOI: 10.1590/s1677-5538.ibju.2021.0560] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer (BCa) is one of the most common cancers worldwide and is also considered to be one of the most relapsing and aggressive neoplasms. About 30% of patients will present with muscle invasive disease, which is associated with a higher risk for metastatic disease. The aim of this article is to review the state of art imaging in Radiology, while providing a complete guide to urologists, with case examples, for the rationale of the development of the Vesical Imaging Reporting and Data System (VI-RADS), a scoring system emphasizing a standardized approach to multiparametric Magnetic Resonance Imaging (mpMRI) acquisition, interpretation, and reporting for BCa. Also, we examine relevant external validation studies and the consolidated literature of mpMRI for bladder cancer. In addition, this article discusses some of the potential clinical implications of this scoring system for disease management and follow-up.
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Affiliation(s)
- Refky Nicola
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Rodolfo Borges Dos Reis
- Departamento de Cirurgia, Divisão de Urologia - Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Valdair Francisco Muglia
- Departamento de Imagens Médicas, Oncologia e Hematologia - Divisão de Imagem, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
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Korkes F, Timóteo F, Soledade LCB, Bugalho LS, Peixoto GA, Teich VD, Glina S. Stage-Related Cost of Treatment of Bladder Cancer in Brazil. PHARMACOECONOMICS - OPEN 2022; 6:461-468. [PMID: 35165828 PMCID: PMC9043045 DOI: 10.1007/s41669-022-00325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Bladder cancer is the ninth most frequent cancer worldwide with the twelfth highest incidence. However, its treatment has financial impacts that directly affect health burden. There is a scarcity of data about the costs related to healthcare in Brazil, especially in the public setting. As previously demonstrated, despite not being one of the most frequent cancers, bladder cancer appears to be one of the most expensive. The present study aimed to assess the costs related to the treatment of bladder cancer in the public setting in Brazil. PATIENTS AND METHODS Retrospective data of patients treated for urothelial bladder carcinoma from 2019 to 2020 were retrieved at a single center. All charts were reviewed, with the assessment of clinical data, exams, surgical data, and post-procedure outcomes. The hospital finance department calculated the costs for outpatient evaluation, inpatient procedures, complementary exams, materials, drugs, and professionals' fees throughout all operations. RESULTS A total of 107 patients with bladder cancer were analyzed, representing a total expenditure of BRL 5,671,042.70 and a mean cost of BRL 53,000.04 per patient (US$1.00 = BRL 5.60). Median costs were progressively higher for patients with stages I, II, III, and IV. Patients who underwent radical cystectomy (n = 14) had a median treatment cost of BRL 136,606.25 ± 96,059.08, during a mean follow-up of 9.2 months. Hospitalization costs represented 25% (range 20-43% according to the stage) of all expenditure. Medications and medical supplies represented 18% (16-23% according to the stage) of expenditure. Medical fees represented 31% of costs for stage I disease, but only 4% in stage II, III, and IV. Costs associated with emergency room visits were only observed in stage III and IV disease, representing 1% of all expenditure. CONCLUSIONS The management of bladder cancer resulted in a significant economic burden on our public health system. The costs associated with stage I bladder cancer were 4-12 times higher than those related to the treatment of other common malignancies at initial stages. Treatment was also expensive during the first months with more advanced stages.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABC, Rua Iguatemi, 192, cj 23, São Paulo, SP, Brazil.
- Hospital Municipal da Vila Santa Catarina, São Paulo, Brazil.
- Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Frederico Timóteo
- Faculdade de Medicina do ABC, Rua Iguatemi, 192, cj 23, São Paulo, SP, Brazil
- Hospital Municipal da Vila Santa Catarina, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Guilherme A Peixoto
- Faculdade de Medicina do ABC, Rua Iguatemi, 192, cj 23, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Sidney Glina
- Faculdade de Medicina do ABC, Rua Iguatemi, 192, cj 23, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Korkes F, Spiess PE, Garcia-Perdomo HA, Necchi A. Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review. Int Braz J Urol 2022; 48:397-405. [PMID: 34156188 PMCID: PMC9060175 DOI: 10.1590/s1677-5538.ibju.2021.0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. MATERIALS AND METHODS Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. RESULTS A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. CONCLUSION For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABCDisciplina de UrologiaSanto AndreSPBrasilDisciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo Andre, SP, Brasil
- Hospital Israelita Albert EinsteinDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Phillipe E. Spiess
- H. Lee Moffitt Cancer Center and Research InstituteDepartment of Genito-Urinary OncologyTampaFLEUADepartment of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, EUA
- University of South Florida University of South FloridaDepartment of Urology and OncologyTampaFLEUADepartment of Urology and Oncology, University of South Florida University of South Florida, Tampa, FL, EUA
| | - Herney Andres Garcia-Perdomo
- Universidad Del ValleSchool of MedicineDepartment of SurgeryCaliColômbiaDivision of Urology / Urooncology, Department of Surgery, School of Medicine, Research Group - UROGIV, Universidad Del Valle, Cali, Colômbia
| | - Andrea Necchi
- University Vita-Salute San RaffaeleDiscipline of UrologyMilanItalyDiscipline of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Monteiro CRDA, Korkes F, Krutman-Zveibil D, Glina S. Fibroblast growth factor receptor 3 gene (FGFR3) mutations in high-grade muscle-invasive urothelial bladder cancer in a Brazilian population: evaluation and prevalence. EINSTEIN-SAO PAULO 2022; 20:eAO6450. [PMID: 35384983 PMCID: PMC8967311 DOI: 10.31744/einstein_journal/2022ao6450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To understand the feasibility of FGFR3 tests in the Brazilian public health context, and to sample the mutational burden of this receptor in high-grade muscle invasive bladder cancer. Methods A total of 31 patients with high-grade muscle-invasive bladder cancer were included in the present study. Either transurethral resection of bladder tumor or radical cystectomy specimens were analyzed. Formalin-fixed paraffin-embedded tissue blocks were sectioned, hematoxylin and eosin stained, and histologic sections were reviewed. Total RNA was extracted using the RNeasy DSP formalin-fixed paraffin-embedded kit. Qualitative results were displayed in Rotor-Gene AssayManager software. Results Six patients were excluded. From the samples analyzed, four (16.7%) were considered inadequate and could not have their RNA extracted. Two patients presented FGFR3 mutations, accounting for 9.5% of material available for adequate analysis. The two mutations detected included a Y373C mutation in a male patient and a S249C mutation in a female patient. Conclusion FGFR3 mutations could be analyzed in 84% of our cohort and occurred in 9.5% of patients with high-grade muscle invasive bladder cancer in this Brazilian population. FGFR3 gene mutations are targets for therapeutic drugs in muscle-invasive bladder cancer. For this reason, know the frequency of these mutations can have a significant impact on public health policies and costs provisioning.
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Korkes F, Timóteo F, Ferrari KL, Reis LO. Bacillus Calmette-Guérin (BCG) Brazilian Backstage in Bladder Cancer. Int Braz J Urol 2021; 47:232-236. [PMID: 33284531 PMCID: PMC7857746 DOI: 10.1590/s1677-5538.ibju.2021.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABC-FMABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC-FMABC, Santo André, SP, Brasil.
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil.
| | - Frederico Timóteo
- Faculdade de Medicina do ABC-FMABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC-FMABC, Santo André, SP, Brasil.
| | - Karen Linares Ferrari
- Universidade Estadual de Campinas - UnicampCampinasSPBrasilUroScience, Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil.
| | - Leonardo Oliveira Reis
- Universidade Estadual de Campinas - UnicampCampinasSPBrasilUroScience, Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil.
- Pontifícia Universidade Católica de Campinas - PUC-CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil.
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