Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates. As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors and be aware of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. To highlight the challenges and opportunities to serve these survivors, the American Cancer Society and the National Cancer Institute estimated the prevalence of cancer survivors on January 1, 2012 and January 1, 2022, by cancer site. Data from Surveillance, Epidemiology, and End Results (SEER) registries were used to describe median age and stage at diagnosis and survival; data from the National Cancer Data Base and the SEER-Medicare Database were used to describe patterns of cancer treatment. An estimated 13.7 million Americans with a history of cancer were alive on January 1, 2012, and by January 1, 2022, that number will increase to nearly 18 million. The 3 most prevalent cancers among males are prostate (43%), colorectal (9%), and melanoma of the skin (7%), and those among females are breast (41%), uterine corpus (8%), and colorectal (8%). This article summarizes common cancer treatments, survival rates, and posttreatment concerns and introduces the new National Cancer Survivorship Resource Center, which has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, health care professionals, advocates, and policy makers.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21149

Cancer treatment and survivorship statistics, 2012

The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21565

Cancer treatment and survivorship statistics, 2019

Urologic diseases in america project: urolithiasis

Urologic diseases in america project: benign prostatic hyperplasia

/pdf/health-research-data-for-the-real-world-the-marketscan-55s9bjjvp0.pdf

HealtH ReseaRcH Data foR tHe Real WoRlD: tHe MaRketscan ® Databases

Urologic diseases in America Project: analytical methods and principal findings.

BACKGROUND

Patients with bladder cancer are apt to develop multiple recurrences that require intervention. The recurrence, progression, and bladder cancer–related mortality rates were examined in a cohort of individuals with high-grade non–muscle-invasive bladder cancer.



METHODS

Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, subjects were identified who had a diagnosis of high-grade, non–muscle-invasive disease in 1992 to 2002 and who were followed until 2007. Multivariate competing-risks regression analyses were then used to examine recurrence, progression, and bladder cancer–related mortality rates.



RESULTS

Of 7410 subjects, 2897 (39.1%) experienced a recurrence without progression, 2449 (33.0%) experienced disease progression, of whom 981 succumbed to bladder cancer. Using competing-risks regression analysis, the 10-year recurrence, progression, and bladder cancer–related mortality rates were found to be 74.3%, 33.3%, and 12.3%, respectively. Stage T1 was the only variable associated with a higher rate of recurrence. Women, black race, undifferentiated grade, and stage Tis and T1 were associated with a higher risk of progression and mortality. Advanced age (≥ 70) was associated with a higher risk of bladder cancer–related mortality.



CONCLUSIONS

Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within 10 years of their diagnosis. Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer. Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first 2 years of diagnosis warrants an intense surveillance schedule. Cancer 2013;119:3219–3227. © 2013 American Cancer Society.

Recurrence of high-risk bladder cancer: a population-based analysis.

BACKGROUND:

Clinical practice guidelines for the management of patients with bladder cancer encompass strategies that minimize morbidity and improve survival. In the current study, the authors sought to characterize practice patterns in patients with high-grade non–muscle-invasive bladder cancer in relation to established guidelines.



METHODS:

Surveillance, Epidemiology and End Results (SEER)-Medicare–linked data were used to identify subjects diagnosed with high-grade non–muscle-invasive bladder cancer between 1992 and 2002 who survived at least 2 years without undergoing definitive treatment (n = 4545). The authors used mixed-effects modeling to estimate the association and partitioned variation of patient sociodemographic, tumor, and provider characteristics with compliance measures.



RESULTS:

Of the 4545 subjects analyzed, only 1 received all the recommended measures. Approximately 42% of physicians have not performed at least 1 cystoscopy, 1 cytology, and 1 instillation of immunotherapy for a single patient nested within their practice during the initial 2-year period after diagnosis. After 1997, only use of radiographic imaging (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.03-1.37) and instillation of immunotherapy (OR, 1.67; 95% CI, 1.39-2.01) were found to be significantly increased. Surgeon-attributable variation for individual guideline measures (cystoscopy, 25%; cytology, 59%; radiographic imaging, 10%; intravesical chemotherapy, 45%; and intravesical immunotherapy, 26%) contributes to this low compliance rate.



CONCLUSIONS:

There is marked underuse of guideline-recommended care in this potentially curable cohort. Unexplained provider-level factors significantly contribute to this low compliance rate. Future studies that identify barriers and modulators of provider-level adoption of guidelines are critical to improving care for patients with bladder cancer. Cancer 2011;. © 2011 American Cancer Society.

Compliance with guidelines for patients with bladder cancer: variation in the delivery of care.

BACKGROUND.

Most urologists specializing in the management of patients with bladder cancer consider continent urinary diversion the reconstructive technique that affords the best quality of life after radical cystectomy. The authors sought to evaluate factors that predict reconstructive technique after radical cystectomy.



METHODS.

Using linked data from Medicare and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, 3611 subjects were identified who underwent radical cystectomy for bladder cancer between 1992 and 2000. Multivariate logistic regression was used to identify factors independently associated with utilization of continent reconstruction after radical cystectomy, incorporating patient and provider variables.



RESULTS.

In multivariate analysis, the likelihood of continent diversion was inversely associated with older age (odds ratio [OR] ≤0.68, P ≤ .002), African American race (OR 0.43, P = .003), and higher comorbidity index (OR 0.71, P = .03), and directly associated with male sex (OR 1.45, P = .002), higher education level (OR 1.54, P = .03), and year of surgery (OR ≥ 1.56, P < .001 for all year categories vs. 1992–1994). Treatment at academic (OR 1.43, P = .003) and NCI-designated cancer centers (OR 5.50, P < .001) and by high-volume providers (OR 1.49, P < .001) was independently associated with continent reconstruction.



CONCLUSIONS.

Disparities in the utilization of continent urinary diversion after radical cystectomy suggest that demographic, socioeconomic, provider-based, and clinical variables predict the likelihood that those undergoing radical cystectomy will receive continent reconstruction. Regionalization of bladder cancer care may ameliorate many of the disparities noted but must be balanced against the risk imposed by a delay in care. Cancer 2006. © 2006 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.22058

Variations in reconstruction after radical cystectomy.

The National Inpatient Sample was examined, and 27 494 patients who underwent RC with urinary diversion between 2001 and 2005 were identified. Of those, 16.5% received a continent diversion, and the remaining 83.5% received an ileal conduit. Medical complications were subdivided into cardiovascular, respiratory, and other; surgical complications included bowel, urinary, wound, and others. The authors found that for all medical complications, continent diversion subjects averaged a 2.8% lower risk, and similarly, the risk of any surgical complication was 5% lower in comparison to recipients of ileal conduits. The authors conclude that the study shows that the type of urinary diversion after RC is not associated with the risk of immediate postoperative medical and surgical complications. The authors expect that these results may decrease provider reluctance to consider a more complex urinary diversion when counseling patients with invasive bladder cancer about reconstruction options after RC. Expert’s comments: This study gives a picture of the current surgical attitude with regard to urinary diversion: One continent reservoir is constructed for every four ileal conduits. A few key points should be highlighted. More detailed data regarding the characteristics of the multi-institutional, nationwide series examined (ie, cancerspecific characteristics, prior surgery or chemotherapy, number of readmissions) are not given in the study. This limitation is acknowledged by the authors. The influence of the primary payer is difficult to calculate, but continent diversions were less common among subjects with Medicare as the primary payer. Among the health systems of most European countries, this factor is less limiting than in the United States. Finally, a trend toward increased comorbidities was present among recipients of ileal conduits and was significant for valvular disease, hypothyroidism, and obesity. The message of the study is that age and comorbidities raise the risk of complications more significantly than the type of urinary diversion. The geriatric population is expanding in Western Europe, and this growth emphasizes the need for perioperative management plans aimed at the prevention of complications [2] and the accurate and thorough medical assessment of the elderly population [3]. Conflicts of interest: The author has nothing to disclose.

/pdf/urinary-diversion-and-morbidity-after-radical-cystectomy-for-2aigsg22eh.pdf

Jan M. Hanley

Papers

Urologic diseases in America Project: analytical methods and principal findings.

Recurrence of high-risk bladder cancer: a population-based analysis.

Compliance with guidelines for patients with bladder cancer: variation in the delivery of care.

Variations in reconstruction after radical cystectomy.

Urinary diversion and morbidity after radical cystectomy for bladder cancer.