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Pfizer-200x80 This project is sponsored by EMD Serono and Pfizer.

 

Bladder Cancer

As with all cancers, a bladder cancer diagnosis can be scary and overwhelming for both patients and their caregivers. Compared to other cancer types, however, patient experience of bladder cancer care is especially poor. Depending on the cancer type and stage, discomfort from procedures and psychological stress can diminish quality of life in terms of fatigue, physical functions, and mental health.

Beyond treatment, side effects such as urinary incontinence, waking during the night to urinate, changes to sexual function, and altered body image, all contribute to psychological stress. Additionally, a bladder cancer diagnosis can affect a person’s quality of life because it requires life-long care such as stoma care, catheterization, or ensuring access to bathrooms.

Large studies using the National Cancer Database (NCDB) report that Black, female, uninsured, or Medicaid patients with any stage of bladder cancer are less likely than other patient populations to receive cancer-directed therapies. The cause of these disparities includes many factors such as referral delays, insurance authorization delays, patient preference, socioeconomic status, and limited access to high-volume treatment centers.

ACCC is providing resources for providers to recognize and address these barriers to guideline-concordant care.

Bladder Cancer Risk Factors

The most common risk factors for bladder cancer include smoking, workplace exposure, use of certain medications or herbal supplements, and the presence of arsenic in the drinking water. Bladder birth defects, urinary tract infections (UTIs), kidney/bladder stones, long-term bladder catheters, and chronic bladder irritation have also been linked to bladder cancer (particularly squamous cell carcinoma).

Interactive eCourse

Implementing Shared Decision-Making in Bladder Cancer Care

ACCC’s Implementing Shared Decision-Making in Bladder Cancer Care e-Course supports quality person-centered care by educating the multidisciplinary bladder cancer care team on health literacy and health equity best practices and shared decision-making conversations. Through this brief online course, oncology professionals can better address the existing barriers to quality bladder cancer care for underserved populations and improve care coordination for improved health outcomes.

Cancer programs and academic centers can implement quality improvement steps to optimize the delivery of guideline-based treatment for vulnerable patients with bladder cancer and, in doing so, prevent disparities in treatment delivery and outcomes.
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Featured Program: Multidisciplinary Bladder Cancer Care

A mark of a cohesive multidisciplinary cancer care team is the development and utilization of effective patient education practices and resources. Many cancer care teams embrace a patient-centered multidisciplinary care approach. Research continues to affirm its effectiveness.

Through this education project, ACCC is examining the barriers cancer care teams face when engaging patients in treatment and surveillance, including examples to show the impact of disparities in care and the costs attributed to the delay of treatment. Additionally, ACCC is developing operational tools for providers to use for the implementation of changes in their programs and communities, offering real-world examples of best practices in screening and identification of patients with bladder cancer, as well as strategies for delivering quality care to underserved populations.

For more information on this project, please contact the ACCC Provider Education department.

Cancer Buzz Podcasts

  • Examining Shared Decision-Making in Bladder Cancer Care — [PODCAST] EP 133
    Sep 28, 2023

    Disparities in bladder cancer care persist, especially with respect to race. In fact, patient demographics has a proven impact on health outcomes. Listen in as CancerBuzz speaks to Mary W. Dunn, MSN, RN, OCN, NP-C, Adult Nurse Practitioner of Urology and Medical Oncology at the UNC Lineberger Comprehensive Cancer Center and Samuel L. Washington III, MD, MAS, Assistant Professor of Urology at the University of California, San Francisco, about health literacy, shared decision-making, and educational resources being developed by ACCC.

Featured Publication: Understanding and Mitigating Disparities in Bladder Cancer Care


Understanding-and-Mitigating-Disparities-in-Bladder-Cancer-Care-300x376This article explores disparities in bladder cancer, including data collected through a 2021 Bladder Cancer Economic Study by the Association of Community Cancer Centers (ACCC). It offers practical and operational tips for oncology care team members to manage underserved patients with bladder cancer.
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From the ACCCBuzz Blog

Get the Facts About Bladder Cancer


May 20, 2021
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Each May, the World Bladder Cancer Patient Coalition hosts Bladder Cancer Awareness Month to highlight the facts about bladder cancer, promote awareness about the disease, and call for more investment in research, treatment, and care. This year’s theme emphasizes the importance promoting conversations about bladder cancer and its symptoms, treatments, and management. Poor patient engagement can lead to poor adherence, poor symptom management, and disparities in outcomes among different groups.  

 

Gender Differences 

 

Historically viewed as a disease of older white men, the reality of bladder cancer is more nuanced. It is the 7th-most common cancer in the U.S., the 4th-most common cancer for men, and the 11th-most common cancer for women. The American Cancer Society projects that about 83,730 new cases of bladder cancer (approx. 64,280 in men and 19,450 in women) will be diagnosed in the U.S. in 2021. Overall, the chance a man will develop bladder cancer in his lifetime is about 1 in 27. For women, it is about 1 in 89. However, bladder cancer is more lethal in women than in men. Compared to men, women present with more advanced bladder cancer, have a greater risk of recurrence, and experience worse overall survival. 

 

Racial Disparities 

 

Like many cancers, the incidence and treatment of bladder cancer is marked by racial disparities. Although White patients have twice the incidence rate of bladder cancer as Black patients, the latter present with more advanced disease (higher grade and stage tumors), and have up to 10 percent worse disease-specific survival than White patients. Black patients are also less likely to receive aggressive treatment than White patients. While the overall 5-year survival rate for bladder cancer is 77 percent, it is 64 percent for Black patients. 

 

Patient Education 

 

Enhanced health literacy and improved patient/provider communication could do much to disrupt these disparities and enhance overall outcomes. Research has documented the unmet supportive care needs of patients with bladder cancer across all phases of the cancer care continuum. A 2019 survey of patients with bladder cancer in Canada reported high levels of need for information about medical treatment options, practical strategies for managing bladder cancer, and supportive care resources.  

 

One recently developed resource that specifically targets the needs of patients with bladder cancer is the Bladder Cancer Basics Handbook from the Bladder Cancer Advocacy Network (BCAN). The handbook, available free of charge as a downloadable pdf, teaches patients about their diagnosis and treatment options to help them make informed decisions in collaboration with members of their care team. The handbook describes the types of tests used to diagnose bladder cancer, what it means to stage and grade the disease, the types of treatments prescribed (including recently approved immunotherapies), and additional patient resources. Also available from BCAN is Tips for Caregivers, a companion handbook for patient caregivers that includes helpful tools and resources to navigate the cancer care journey. 

 

Multidisciplinary Care 

 

Developing and employing effective patient education practices and resources is often the mark of a cohesive multidisciplinary cancer care team. Many cancer practices embrace the patient-centered multidisciplinary care approach, and research affirming its effectiveness is ever-growing.  

Recently, a team of clinicians and social workers wrote about the success of a patient-centered, interdisciplinary collaborative model of care created for patients with bladder cancer. The Bladder Patient-Centered Interdisciplinary Team (BPIT) model emphasizes the patient as an active participant in treatment and a member of the care team, along with oncology nurses, wound ostomy and continence nurses, and oncology social workers. When members of the care team are able to efficiently and effectively communicate, consult, and generate discipline- and team-specific care plans, patients benefit. 


ACCC’s Bladder Cancer Education Projects 


ACCC’s education program, Optimizing Outcomes for Urothelial Carcinoma, is designed to give members of the multidisciplinary care team the knowledge they need to address the practical issues and barriers involved in integrating immunotherapy and other novel targeted therapies into the treatment of advanced urothelial carcinoma. An online CME-accredited course on the topic is aimed at helping community clinicians keep current with: evidence-based practice guidelines, the clinical efficacy of new therapies, how to monitor and manage adverse events, and how to engage patients to help them make informed treatment decisions. 

Stay tuned for more tools for the cancer care team from ACCC in the upcoming project, Multidisciplinary Bladder Cancer Care, which will address barriers to engaging patients in treatment and surveillance, the impact of disparities in care, and the costs of delaying treatment due to constrained financial and clinical resources.

Featured Resources

Bladder Cancer Patient Guide 
Providing Equitable Care to Patients with Bladder Cancer

This equity-oriented care guide for patients with bladder cancer identifies roadblocks that patients with bladder cancer may encounter and what actions can be taken to mitigate disparities and unnecessary risks.
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Effective Practices in Bladder Cancer Care 
Effective Practices in Bladder Cancer Care

This four-part series includes real life examples of programs that are making strides in the multidisciplinary approach to bladder cancer, showcasing the benefits of:

 

Abstracts & Presentations