Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project

Fernando Korkes; Frederico Timóteo; Suelen Martins; Matheus Nascimento; Camila Monteiro; José H Santiago; Willy Baccaglini; Marcel A Silveira; Eduardo F Pedroso; Marcello M Gava; Prashant Patel; Phillipe E Spiess; Sidney Glina

doi:10.1200/GO.21.00104

Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project

Fernando Korkes, Frederico Timóteo, Suelen Martins, Matheus Nascimento, Camila Monteiro, José H Santiago, Willy Baccaglini, Marcel A Silveira, Eduardo F Pedroso, Marcello M Gava, Prashant Patel, Phillipe E Spiess, Sidney Glina

Cancer and Genomic Sciences

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Abstract

PURPOSE: Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil.

PATIENTS AND METHODS: A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared.

RESULTS: Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2.

CONCLUSION: Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

Original language	English
Pages (from-to)	1547-1555
Number of pages	9
Journal	JCO Global Oncology
Volume	7
DOIs	https://doi.org/10.1200/GO.21.00104
Publication status	Published - 12 Nov 2021

Keywords

Cystectomy/methods
Female
Humans
Male
Neoadjuvant Therapy
Retrospective Studies
Urinary Bladder/pathology
Urinary Bladder Neoplasms/drug therapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1200/GO.21.00104Licence: Creative Commons: Attribution-NonCommercial-NoDerivs (CC BY-NC-ND)

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Korkes, F., Timóteo, F., Martins, S., Nascimento, M., Monteiro, C., Santiago, J. H., Baccaglini, W., Silveira, M. A., Pedroso, E. F., Gava, M. M., Patel, P., Spiess, P. E., & Glina, S. (2021). Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project. JCO Global Oncology, 7, 1547-1555. https://doi.org/10.1200/GO.21.00104

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title = "Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project",

abstract = "PURPOSE: Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil.PATIENTS AND METHODS: A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared.RESULTS: Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2.CONCLUSION: Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.",

keywords = "Cystectomy/methods, Female, Humans, Male, Neoadjuvant Therapy, Retrospective Studies, Urinary Bladder/pathology, Urinary Bladder Neoplasms/drug therapy",

author = "Fernando Korkes and Frederico Tim{\'o}teo and Suelen Martins and Matheus Nascimento and Camila Monteiro and Santiago, {Jos{\'e} H} and Willy Baccaglini and Silveira, {Marcel A} and Pedroso, {Eduardo F} and Gava, {Marcello M} and Prashant Patel and Spiess, {Phillipe E} and Sidney Glina",

year = "2021",

month = nov,

day = "12",

doi = "10.1200/GO.21.00104",

language = "English",

volume = "7",

pages = "1547--1555",

journal = "JCO Global Oncology",

issn = "2687-8941",

publisher = "American Society of Clinical Oncology",

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Korkes, F, Timóteo, F, Martins, S, Nascimento, M, Monteiro, C, Santiago, JH, Baccaglini, W, Silveira, MA, Pedroso, EF, Gava, MM, Patel, P, Spiess, PE & Glina, S 2021, 'Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project', JCO Global Oncology, vol. 7, pp. 1547-1555. https://doi.org/10.1200/GO.21.00104

TY - JOUR

T1 - Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality

T2 - the CABEM project

AU - Korkes, Fernando

AU - Timóteo, Frederico

AU - Martins, Suelen

AU - Nascimento, Matheus

AU - Monteiro, Camila

AU - Santiago, José H

AU - Baccaglini, Willy

AU - Silveira, Marcel A

AU - Pedroso, Eduardo F

AU - Gava, Marcello M

AU - Patel, Prashant

AU - Spiess, Phillipe E

AU - Glina, Sidney

PY - 2021/11/12

Y1 - 2021/11/12

N2 - PURPOSE: Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil.PATIENTS AND METHODS: A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared.RESULTS: Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2.CONCLUSION: Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

AB - PURPOSE: Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil.PATIENTS AND METHODS: A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared.RESULTS: Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2.CONCLUSION: Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

KW - Cystectomy/methods

KW - Female

KW - Humans

KW - Male

KW - Neoadjuvant Therapy

KW - Retrospective Studies

KW - Urinary Bladder/pathology

KW - Urinary Bladder Neoplasms/drug therapy

U2 - 10.1200/GO.21.00104

DO - 10.1200/GO.21.00104

M3 - Article

C2 - 34767463

SN - 2687-8941

VL - 7

SP - 1547

EP - 1555

JO - JCO Global Oncology

JF - JCO Global Oncology

ER -

Dramatic impact of centralization and a multidisciplinary bladder cancer program in reducing mortality: the CABEM project

Abstract

Keywords

UN SDGs

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