Bladder Cancer - Volume Pre-press, issue Pre-press

Authors: Jung, Ahrang | Song, Lixin | Snyder, Elizabeth | Louwers, Renata K. | Sachse, Karen | Chisolm, Stephanie | Gore, John L. | Smith, Angela B.

Article Type: Research Article

Abstract: BACKGROUND: The unique burden of treatment and survivorship of patients with bladder cancer can negatively impact caregiver experience and their use of supportive care resources. OBJECTIVE: To assess caregivers’ well-being and their perception of potential supportive resources. METHODS: In this cross-sectional survey, caregivers of patients with bladder cancer (N = 630) were recruited through the nationwide Bladder Cancer Advocacy Network Patient Survey Network. We used stakeholder-developed questionnaires to examine caregiver well-being (i.e., physical well-being, tiredness, fear, worry, sadness), the perceived helpfulness of potential resources (i.e., web-based and print-based information, specialized support, personal stories of other caregivers, phone-call and …online chat with other caregivers), and influencing factors. RESULTS: Caregivers more frequently reported emotional well-being as a moderate to serious problem (67% for fear, 78% for worry, 66% for sadness) compared with physical well-being (30% ) and tiredness (47% ). Decreased well-being was associated with female gender of the caregiver, higher than high school education, or caring for a patient with advanced (versus non-invasive) bladder cancer. Of six potential resources, “web-based information” was perceived as “very helpful” among 79% of respondents, followed by “personal stories from other caregivers” (62% ). Caregiver preferences for “web-based information” was not associated with any specific demographic or clinical factors. CONCLUSIONS: Caregivers reported moderate to serious problems with emotional and physical well-being. Web-based platforms were perceived as beneficial supportive resources for bladder cancer caregivers. Future intervention research should target the influencing factors identified in this study to optimize the health outcomes of caregivers and enhance the supportive care resources for improving their well-being. Show more

Keywords: Urinary bladder neoplasms, caregivers, health resources, patient care, social support

DOI: 10.3233/BLC-200412

Citation: Bladder Cancer, vol. Pre-press, no. Pre-press, pp. 1-10, 2020

Authors: Meeks, Joshua J. | Sjödahl, Gottfrid | Lerner, Seth P. | Das, Arighno | McConkey, David J. | Black, Peter C.

Article Type: Research Article

Abstract: BACKGROUND: Bladder cancers have high total mutation burdens resulting in genomic diversity and intra- and inter-tumor heterogeneity that may impact the diversity of gene expression, biologic aggressiveness, and potentially response to therapy. To compare bladder cancers among patients, an organizational structure is necessary that describes the tumor at the histologic and molecular level. These “molecular subtypes”, or “expression subtypes” of bladder cancer were originally described in 2010 and continue to evolve secondary to next generation sequencing (NGS) and an increasing public repository of well-annotated cohorts. OBJECTIVE: To review the history and methodology of expression-based subtyping of non-muscle invasive …(NMIBC) and muscle invasive bladder cancer (MIBC). METHODS: A literature review was performed of primary papers from PubMed that described subtyping methods and their descriptive feature including search terms of “subtype”, and “bladder cancer”. RESULTS: 21 papers were identified for review. Tumor subtyping developed from N = 2 to N = 6 subtyping schemes with most subtypes comprised of at least luminal and basal tumors. Most NMIBCs are luminal cancers and luminal MIBCs may be associated with less aggressive features, while one study of basal tumors identified a better clinical outcome with systemic chemotherapy. Tumors with a 53-like signature may have intrinsic resistance to chemotherapy. The heterogeneity of tumors, which is likely derived from stromal components and immune cell infiltration, affect subtype calls. CONCLUSION: Subtyping, while still evolving, is ready for testing in clinical trials. Improved patient selection with tumor subtyping may help with tumor classification and potentially match patient or tumor to therapy. Show more

Keywords: Bladder cancer, expression-based subtyping, stroma, immunology, systemic therapy

DOI: 10.3233/BLC-200306

Citation: Bladder Cancer, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Cooley, Lauren Folgosa | Weiner, Adam B. | Meng, Xiaosong | Woldu, Solomon L. | Meeks, Joshua J. | Lotan, Yair

Article Type: Research Article

Abstract: BACKGROUND: There is insufficient data to recommend screening for bladder cancer (BC). For future BC screening trials, it is important to understand how and if tumor (T) stage can act as a surrogate outcome marker for overall (OS) and cancer-specific (CSS) survival. OBJECTIVE: To characterize OS and CSS between primary tumor (T) stages in non-metastatic bladder cancer (BC) patients. METHODS: Non-metastatic BC patients were identified in the National Cancer Database (NCDB; 2004-2015) (n = 343,163) and National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER) (n = 130,751). Cox multivariable regression compared relationships between T stage (LGTa, HGTa, Tis, …LGT1, HGT1, T2-T4) and OS or CSS for all patients and sub-cohorts. RESULTS: Compared to stage LGTa as a reference, overall (SEER; NCDB) and cancer-specific (SEER) survival significantly declined with increasing T stage. Using SEER, OS ranged from HGTa (HR 1.16, CI 1.13– 1.21, p  <  0.001) to T4 (HR 5.70, CI 5.41– 6.00, p  <  0.001) with a steep inflection between HGT1 (HR 1.68, CI 1.63– 1.73, p  <  0.001) and T2 (HR 3.39, CI 3.30– 3.49, p  <  0.001), which was verified with NCDB. The association of stage and CSS was even more pronounced: HGTa (84% 10 year-CSS, HR 1.94, CI 1.81– 2.08, p  <  0.001), Tis (82% 10 year-CSS, HR 2.28, CI 2.09– 2.47, p  <  0.001), LGT1 (84% 10 year-CSS, HR 2.30, CI 2.11– 2.51, p  <  0.001), HGT1 (72% 10 year-CSS, HR 4.24, CI 4.01– 4.47, p  <  0.001), T2 (48% 10 year-CSS, HR 12.18, CI 11.57– 12.82, p  <  0.001), T3 (45% 10 year-CSS, HR 14.60, CI 13.63– 15.64, p  <  0.001), and T4 (29% 10 year-CSS, HR 22.76, CI 21.19– 24.44, p  <  0.001). CONCLUSIONS: Earlier T stage at diagnosis is associated with better OS largely due to differences in CSS. A clinically significant difference between Stage I and Stage II is verified herein in multiple cohorts. Therefore, earlier stage at diagnosis, specifically preventing muscle invasive BC, could potentially improve survival. Show more

Keywords: Urinary bladder neoplasms, neoplasm staging, early detection of cancer, epidemiology, survival

DOI: 10.3233/BLC-200381

Citation: Bladder Cancer, vol. Pre-press, no. Pre-press, pp. 1-9, 2020