Bladder cancer 2016: 'Coordinated care pathways' and immunotherapy
January 1, 2016 | by Veronique de Turenne
Shorter hospital stays and reduced readmission rates – those are the goals for bladder cancer patients at City of Hope in 2016. Uniquely coordinated care will make that possible.
At the same time, here and nationwide, advances in immunotherapy will make 2016 a year of progress overall.
To learn more, we spoke with two of City of Hope’s bladder cancer experts, Kevin Chan, M.D., head of reconstructive urology, and Sumanta Pal, M.D., assistant clinical professor in the Department of Medical Oncology & Therapeutics Research.
Chan, a urologic surgeon, is an associate clinical professor in the Department of Surgery. In addition to his clinical work, Chan conducts research in surgical techniques and postoperative care. The goal of his research is to improve outcomes and minimize complications in patients with bladder cancer.
Pal, co-director of the Kidney Cancer Program, joined City of Hope in 2009. He has published more than 80 papers in peer-reviewed journals and presented his work in numerous forums around the world.
Here, Chan and Pal answer five questions about the future of treatment and research in the field of bladder cancer.
1. What treatment advances do you expect for bladder cancer patients in 2016?
Chan: We have created something unique at City of Hope – the coordinated care ‘pathway.’ In this coordinated care pathway, everyone becomes involved in a patient’s case, from me to the other doctors, the case managers, the nurses and the social workers. It is a team approach.”
Pal: Research into checkpoint inhibitors, which harness the power of a patient’s own immune system to fight cancer, shows a lot of promise.
Also, we may see the emergence of more definitive data for immune-based treatments for bladder cancer.
2. How significant are these advances?
Chan: The rate of complications for patients with bladder cancer who have undergone reconstructive surgery is quite high. Because the coordinated care pathway includes a daily meeting by the team that is caring for a patient, the staff can immediately address potential complications, such as infection and dehydration.
Pal: There have been few significant treatment advances in bladder cancer for several decades.
For the past 30 years, we have had to rely on traditional chemotherapy, with rather poor outcomes. Now, in certain patients, these new immune-based treatments can offer the promise better outcomes.
3. How will these advances improve the patient experience or patient outcomes?
Chan: Our coordinated care pathway has already shown to be quite promising. Hospital stays have decreased by two days, and we are seeing decreased readmission rates after surgery.
Overall, patient satisfaction has risen thanks to the coordinated care pathway.
Pal: Those patients who can receive immune-based treatment can generally expect better outcomes and fewer side effects.
Before, traditional chemotherapy used to cause a whole host of side effects such as nausea, vomiting, fatigue and so on. Now, immune-based treatments have improved quality of life in all respects. Patients may live longer and may have less suffering due to side effects.
4. What research progress do you expect in 2016?
Chan: More than 70 patients are presently part of the coordinated care pathway program. We are collating and analyzing the data and will probably publish our results about the effectiveness of the coordinated care pathway sometime this year.
Pal: Researchers are now assessing a combination of chemotherapy and a genetic pathway that damages the DNA of cancer cells.
Cancer cells have a unique mechanism of repairing their DNA to make them less susceptible to chemotherapy. By combining these classes of therapeutic agents, we hope to make bladder cancer cells more susceptible to the effects of chemotherapy.
5. Overall, where is the field of bladder cancer treatment and research moving?
Chan: Researchers are studying a number of gene expression models to help identify which tumors will respond to chemotherapy. Further, advances in cancer biology will help oncologists understand why bladder cancer recurs in some patients and not in others.
Also, checkpoint inhibitors have made a big difference in all of the cancers and I’m highly optimistic that all of these advances show a lot of promise on multiple levels for both early and advanced disease.
Pal: Research into biomarkers in the urine or blood that can reveal the presence of cancer is extremely promising, as is work to usethe genetic profile of a cancer cell to discover ways to kill it.
We are beginning to do more genetic profiling in bladder cancer patients as a way of pointing us to the correct therapy. In the future we will identify the mutations in a bladder cancer cell in the same context that is now used in breast cancer and lung cancer.”
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