Robotic-Assisted Radical Bladder Surgery Potentially Benefits Bladder Cancer Patients

About 30 percent of the more than 70,000 bladder cancer cases expected in 2012 are muscle invasive. In such cases, radical cystectomy is the preferred treatment. In a pilot trial, a team of investigators assessed the efficacy of open radical cystectomy (ORC) vs. robotic-assisted laparoscopic radical cystectomy (RARC). While there were no significant differences in treatment outcomes, RARC resulted in decreased estimated blood loss and shorter hospital stay compared to ORC. The results are published in the February 2013 issue of The Journal of Urology.

"In the last decade minimally invasive approaches including robotic-assisted approaches have emerged as viable surgical options for many urological malignancies with the promise of decreased morbidity with shorter hospital stays, faster recovery, and less narcotic analgesic requirements," says lead investigator Dipen J. Parekh, MD, Professor and Chairman of the University of Miami Miller School of Medicine's Department of Urology and Director of robotic surgery; formerly at the University of Texas Health Science Center at San Antonio.

The goal of the clinical trial was to provide preliminary data from a single institution's randomized trial that evaluated the benefits of robotic-assisted vs. open surgery in patients with invasive bladder cancer. The trial, conducted between July 2009 and June 2011, involved 47 patients and was performed at the University of Texas Health Science Center at San Antonio. Primary eligibility was based on candidacy for an open or robotic approach at the discretion of the treating surgeon. Forty patients were randomized individually and equally to either an ORC or RARC group using a computer randomization program. Each of the two study groups was similar in distribution of age, gender, race, body mass index, previous surgeries, operative time, postoperative complications, and final pathological stage.

Investigators evaluated five surgery outcome factors: Estimated blood loss, operative time from incision to closure, transfusion requirements, time to return of bowel function, and length of stay.

The robotic group experienced significantly decreased blood loss, accompanied by a trend toward faster return of bowel function, fewer hospitalizations beyond five days, and fewer transfusions.

"The strength of our study is the prospective randomized nature that eliminates selection biases that may have been present in prior retrospective analyses," says Dr. Parekh. "We also believe that our study demonstrates that a prospective randomized trial comparing traditional open and robotic approaches in bladder cancer is possible."

This investigative team has joined with several institutions nationally to build on its study and has started an advanced randomized clinical trial among multiple institutions to further compare and assess open vs. robotic-assisted radical cystectomy among patients with invasive bladder cancer. It plans to collect intermediate and long-term survival data from these same patients as well as data on quality of life, daily living activities, handgrip strength, and mobility.

Cancer Screening Rates Have Fallen In US

Despite evidence that earlier diagnosis and improved treatment increases survival, rates of people seeking preventive cancer screening have fallen in the US in the last ten years. Failure of leading bodies to agree screening guidelines, plus reductions in workers with insurance cover could be among reasons for the decline, suggest researchers from the University of Miami Miller School of Medicine.
They write about their NIH-funded study in a paper published 27 December in the online open-access journal Frontiers in Cancer Epidemiology.

In the US, although numbers of cancer survivors have gone up as a result of improved diagnosis and treatment, cancer is still one of the most prominent chronic diseases that in 2011 killed more than 570,000 people.

Alongside a fall in rates of advanced cancer diagnoses in the US in the last ten years, has been an increase in the number of cancer survivors returning to work. The researchers suggest, in their background information, that keeping to a cancer screening schedule could be an important factor (as this helps detect secondary tumors early and reduce potentially limiting side effects).

However, their analysis reveals that although cancer survivors tend to show much higher rates of screening adherence, their numbers too have started falling off in the last three years.

Lead author Tainya Clarke, a research associate in the School's Department of Epidemiology and Public Health, says in a statement:

"There is a great need for increased cancer prevention efforts in the US, especially for screening as it is considered one of the most important preventive behaviors and helps decrease the burden of this disease on society in terms of quality of life, the number of lives lost and insurance costs."

"But despite this, our research has shown that adherence rates for cancer screenings have generally declined with severe implications for the health outlook of our society," she adds.

In January 2012, a new report by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) showed that the percentage of people screened for cancer in the US remains below national targets for 2020, with rates lower among Asian and Hispanic Americans than other groups.

The NIH Study Also Looks at Workforce

For this latest study, Clarke and colleagues examined cancer screening adherence rates of the general public and cancer survivors and compared them to government-recommended "Healthy People" screening goals.

They looked at screening rates for colorectal, prostate, breast and cervical cancers. Not only did they compare rates between the general population and cancer survivors, but they also looked at rates among workers.

The data on screening rates came from National Health Interview Surveys conducted between 1997 and 2010 that in total covered nearly 174,400 people aged 18 and over. These annual surveys randomly sample the US population by household, and collect demographic and health information, including cancer history and cancer-related health behaviors such as cancer screening.

The Results

When they analyzed the data, Clarke and colleagues found that the general population did not meet the government's "Healthy People" screening goals for any type of cancer, apart from colorectal cancer (for this cancer, 54% of the general population underwent screening: the government's 2010 goal is 50%).

But among cancer survivors, who have a higher risk for cancer, the pattern was quite different. Their screening rates, for all types of cancer except cervical (this fell to 78% over the last ten years), exceeded the government goals.

However, the researchers also noticed a decline in the number of cancer survivors who went for cancer screening in the last three years.

Disparities Among Workers

The NIH Survey results also enabled the researchers to include data on working adult Americans with and without a history of cancer: including more than 7,500 with a history of cancer (representing 3.8 million working cancer survivors), and over 119,300 workers with no history of cancer (representing more than 100 million).

They found that among survivors, white collar workers on the whole had higher cancer screening rates than blue collar workers.

Clarke says this was a key finding that she hopes will lead to changes in employment policies to eliminate disparities among different groups of the working population of cancer survivors.

She hopes it will also spur researchers to look more closely at factors influencing screening rates so as to design better workplace interventions and encourage more workers in all occupations to take up screening.

She and her colleagues speculate that ongoing disputes over screening guidelines among bodies like the United States Preventive Services Task Force, American Cancer Society and others, plus reductions in rates of workers covered by insurance that have occurred in the past decade, may lie behind the trend.