Practice makes perfect in cancer surgery

Researchers determine higher hospital and surgeon volume lead to better outcomes when treating bladder cancer patients

In a new, in-depth research project, Queen’s professors Rob Siemens (Urology) and Christopher Booth (Cancer Care and Epidemiology) investigated what affect higher volume hospitals and surgeons had on the outcomes of patients undergoing a radical cystectomy for bladder cancer in Ontario.

Using data provided by the Institute for Clinical Evaluative Sciences (ICES) the investigators studied 2,802 patients who underwent the procedure between 1994 and 2008 in Ontario and found that higher volume hospital and surgeons were associated with less post-operative complications and better overall survival.

These results are intriguing and will undoubtedly lead to some controversy in their interpretation,” says Dr. Siemens. “We wondered if the processes and interactions that lead to better outcomes for patients treated by higher volume providers can be studied and identified, perhaps leading to improved outcomes for all if adopted by lower volume hospitals and surgeons.

The recent study explored a number of different aspects of bladder cancer care to better understand how quality surgical care is delivered for patients with advanced bladder cancer. The explanations for this volume-outcome relationship still remain mostly unidentified which could be a research project in the future.

This research has only been able to illuminate a small fraction of the factors that explain the improved outcomes of higher volume providers,” says Dr. Siemens. “Some would interpret this as a call to more aggressively support a policy of centralizing care at higher volume hospitals for complex medical/surgical diseases.

Siemens et al., (2014). Processes of Care and the Impact of Surgical Volumes on Cancer-specific Survival: A Population-based Study in Bladder Cancer. Urology, 84: 1049–1057 [Abstract]

Advertisements

Scientists pinpoint bladder cancer patients who could benefit from ‘tumor-softening’ treatment

Scientists in Manchester have identified a protein that could help doctors decide which bladder cancer patients would benefit from a treatment that makes radiotherapy more effective.

The team from The University of Manchester, funded by the Medical Research Council, found that patients whose bladder tumour had high levels of a protein, called ‘HIF-1α’, were more likely to benefit from having carbogen – oxygen mixed with carbon dioxide gas – and nicotinamide tablets at the same time as their radiotherapy. The treatment, called ‘CON’, makes radiotherapy more effective.

By comparing levels of HIF-1α in tissue samples from 137 patients who had radiotherapy on its own or with CON, the researchers found the protein predicted which patients benefited from having CON. High levels of the protein were linked to better survival from the disease when patients had radiotherapy and CON. Patients with low protein levels did not benefit from having CON with their radiotherapy.

The HIF-1α protein indicates low oxygen levels in tumour cells – a state known as ‘hypoxia’. The CON treatment works by adding oxygen to the oxygen-deprived tumour cells which makes them more sensitive to the radiotherapy. The study is published in the British Journal of Cancer (BJC).

Study author, Professor Catharine West, a Cancer Research UK scientist at The University of Manchester, said: “Although we have another biomarker that can predict responsiveness to CON and radiotherapy in bladder cancer patients, our findings tell us a bit more about the characteristics of bladder cancer tumours and how they may respond to this treatment.”

But we desperately need to do more work to find ways to treat those patients who won’t see as much benefit from this. And it’s exactly this type of vital research that we and other scientists will be doing at the Manchester Cancer Research Centre – bringing together a wide range of expertise to revolutionise cancer treatment.

Around 65 people are diagnosed with bladder cancer in Manchester every year. There are around 25 deaths from the disease every year.

Nell Barrie, senior science communications manager at Cancer Research UK, said: “This fascinating new finding could help doctors adapt their treatments to patients with bladder cancer as well as shedding more light on the disease. Deaths from bladder cancer are falling in the UK, but more work needs to be done so that this trend continues. More research is needed to helps us find new and better ways to fight bladder cancer.”

Hunter et al., (2014). Expression hypoxia-inducible factor-1α predicts benefit from hypoxia modification in invasive bladder cancer. Brit. J. Cancer111: 437-443  doi: 10.1038/bjc.2014.315. [Abstract]