Late Follow-Up Care Improves Post-Cystectomy Survival
SAN DIEGO—Late follow-up care, but not perioperative and early follow-up care, is associated with improved patient survival after radical or partial cystectomy for bladder cancer, according to a study findings presented at the American Urological Association annual meeting.
The study also showed that imaging tests and laboratory and total services ordered during follow-up were associated with an increased risk of death, whereas doctor visits and urine testing were associated with decreased risk. Imaging tests accounted for the majority of expenditures.
Seth A. Strope, MD, MPH, of Washington University in Saint Louis, Mo., and colleagues analyzed data from a cohort of patients in the fee-for-service Medicare population from 1992 through 2007 using the Surveillance Epidemiology and End Results (SEER)-Medicare database. The investigators looked at three times periods after surgery: perioperative (up to three months post-operatively); early follow-up (four to six months); and late follow-up (6-24 months). They also classified patients according to tertiles of expenditure.
The investigators found no improvement in survival from follow-up care in the perioperative and early follow-up periods. Follow-up care in the late follow-up period, however, was associated with a 64%, 58%, and 41% decreased risk of death among patients in the low, middle, and high tertile of expenditures, respective, after adjusting for patient, hospital, surgeon, and geographic factors. Further analysis found that doctor visits and urine testing were associated with a 9% and 14% decreased risk of death and imaging, laboratory services, and total services were associated with a 62%, 28%, and 40% increased risk of death.
The authors concluded that imaging tests, which account for the vast majority of expenditures in each tertile, appear to have limited benefit after partial and radical nephrectomy.