Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

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Bladder cancer research insights show disparities for specific groups. Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses highlights from his research study, the value of seeking medical attention and second opinions, and proactive patient advice. 

[ACT]IVATION TIP

“Just do your own research, find what’s available, discuss these options with your provider, look at multiple providers, and get multiple opinions if you can to kind of feel more comfortable with whatever decision you end up making.”

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 Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

Transcript:

Lisa Hatfield:

Dr. Hasan, your study found that certain demographics, including Black and female patients have reduced survival rates. So can you speak a bit about the study and what you think can be done to improve outcomes for these groups?

Dr. Shaakir Hasan:

Sure. So, I think that when it comes to the overall prognosis, the overall, you know, outcomes, the results as to how likely you are to get cured, survive is actually not so different. It’s a little different, but not so different among different groups, be it female, be it African Americans, the bigger issue is that they’re being diagnosed at a later stage. And that just makes care a lot more difficult. So, I think that’s the take home message there is that, going back to, I should just say, the biggest issue here is to look at preventive medicine and to kind of detect these symptoms early, detect bladder cancer early if it’s there, because that will eventually lead to better outcomes regardless of whatever group you belong to.

So, that does mean seeking medical attention early. That does mean addressing things like blood in the urine or just anything that’s off in your genital urinary system to address that early. Now, as far as reduced survival rates stage for stage, which is another thing that we showed, it could be a multitude of things. It could be that certain groups, demographic groups, just are predisposed to worst acting cancers. They could be more aggressive tumors. But there’s also certainly a lot of evidence that shows that certain ethnic groups just don’t get the same care, period.

Maybe they don’t have as much access insurance-wise. Maybe they don’t have the same coverage or they’re not seeking some of the expert care that’s out there. And so that certainly can contribute to worse outcomes, period. We’ve seen this in many different cancers. So, what I would say, what can be done to prevent this? I will again, encourage that those really advocate for themselves and say, look, do your own research, hop on Google and just bladder cancer treatments, plain and simple. And you’ll find a multitude of opportunities of different types of treatments. And you should ask your provider about them. The second you do that, they know you’re engaged. They’re going to engage back with you, and it’ll be much more of like a partnership in your management and your care.

And that will ultimately get you better results. I think another thing one can do is don’t, you know, in the business, in medicine, we call this doctor shopping, so to speak, but it’s not a bad thing, seek other opinions, be comfortable with your physician and be comfortable getting different opinions and seeing what’s all out there because, and we won’t be offended. I encourage all my patients to go get as many opinions as they feel comfortable with, because at the end of the day I want you to be comfortable with your management.

I want you to know what’s out there and you might just have a better fit, whether it’s location, you just like the position better. You like the facilities better, the opportunities, the nursing staff, whatever it might be, there’s going to be a better fit for certain patients in certain areas and you should explore that. So, I think regardless of your economic background, your ethnic background, your gender do this and then you, we kind of, so to speak, level the playing field for whatever type of care you get.

Start with doing your own research, you know, try to find what’s available for you, and you might not understand it all, but that’s okay. Just do your own research, find what’s available, discuss these options with your provider, look at multiple providers, and get multiple opinions if you can to kind of feel more comfortable with whatever decision you end up making.

Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

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How can access to bladder cancer care be improved? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses the impacts of health insurance and socioeconomic factors, the value of preventative care, and proactive advice for all patients to help ensure optimal health.

[ACT]IVATION TIP

“Take it upon yourself, regardless of how you feel, regardless of how good you feel to engage in preventive medicine to seek medical attention, even when you feel good, feel healthy, get routine checkups, because a lot of times you just won’t know what’s going on, you won’t feel it. But we can detect it early without you feeling it. And that could eventually save your life if we catch something early, but just when you want to catch something.”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

 Addressing Disparities in Bladder Cancer Diagnosis and Treatment

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

 Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

Transcript:

Lisa Hatfield:

Dr. Hasan, can you speak to how socioeconomic factors influence access to bladder cancer care? And what suggested strategies can help bridge these gaps for underrepresented patients and families facing bladder cancer?

Dr. Shaakir Hasan:

Sure. So the only factor that we saw that was more significant, more influential on worse prognosis, late diagnosis for bladder cancer was insurance. So even more so than ethnicity and income was the lack of insurance. And this makes sense, right? This makes sense. Again, if you do not have insurance, you probably are not getting routine checkups, you’re not getting that urinalysis, you’re not having that opportunity to mention, oh, yeah, a couple of weeks ago, I saw some blood in the urine, it went away. I don’t know if that’s a big deal or not.

You’re just not going to have that opportunity to talk about this and work this up. So that is, I think, the fundamental issue. I think that’s the most important aspect of everything is to just have initial access, preventative medicine, preventive care to look out for these symptoms that can lead you to a bladder cancer diagnosis. So, certainly I think lack of access is the number one thing, even more so than the minority groups. Of course, there is a strong correlation between the two right certain ethnicity, certain groups, underprivileged groups are going to be less likely to have health care. The question is what to do about it. That’s a lot tougher to answer.

At the end of the day, we ought to figure out how to get better access to care. I would say, please, please prioritize this, prioritize your health care. It’s easy for me to say as a physician, I know that I’m biased here, but all too often, I see people that feel great, look great, just have no complaints and therefore do not seek any care. And I understand that I actually personally, probably go by that doctors make pretty bad patients, by the way, as the saying goes, and I’m probably guilty of this as well.

But what I would tell you is that, what makes cancer so dangerous, regardless of where it is, including bladder is that you tend to not know it’s there until it’s too late. It’s very sneaky. It just hangs out with you until it wants to take over. And you’re never going to know, you know, until it’s too late, unless you kind of act on it early. And so it’s really, really important to find a way. I know it’s expensive. I know it can be difficult, but please don’t make the mistake of thinking just because you look great, you feel great, you’ve never had to see a doctor that you don’t want to take these measures to preventative care.

At the end of the day, health is all you have. You could be the richest person in the world, you can do whatever you love to do. But if you aren’t there, if you aren’t around to experience it, or you can’t be healthy while you do it, it’s kind of worthless, right? So please prioritize your health is what I’d say.

Take it upon yourself, regardless of how you feel, regardless of how good you feel to engage in preventive medicine to seek medical attention, even when you feel good, feel healthy, get routine checkups, because a lot of times you just won’t know what’s going on, you won’t feel it. But we can detect it early without you feeling it. And that could eventually save your life if we catch something early, but just when you want to catch something.

Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

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For bladder cancer diagnosis and treatment, how can inequities be navigated? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses groups that experience disparities in bladder cancer outcomes, factors that may impact outcomes, and proactive patient advice.

[ACT]IVATION TIP

“…if you see something abnormal, again, going back to the blood and the urine, please, get medical advice, please go, address this with your PCP. Again, it may be nothing, but it’s something that’s definitely worth investigating, because it literally could save your life. And then I hope this doesn’t have to be the case…but you do have to kind of be your own advocate if you do notice that you’re getting dismissed…”

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Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

 When Is Immunotherapy Recommended in Bladder Cancer?

When Is Immunotherapy Recommended in Bladder Cancer?

Transcript:

Lisa Hatfield:

Dr. Hasan, can you explain how race and gender might influence a patient’s experience with bladder cancer, particularly in terms of diagnosis and treatment?

Dr. Shaakir Hasan:

All right, now this is a difficult topic to kind of explore, but a very important one. And the reason why it’s difficult, not just because it has some just the terminology a hot button issue, so to speak because it’s really important that we address all of these hot button topics to kind of get the best outcomes for everyone. But  what makes it complicated is if you look at the data, and this is throughout many cancers, bladder cancer included, you will see that certain ethnic groups, certain communities, they end up doing worse, stage for stage or different stages with whatever cancer that they have. And the reason why it’s complicated is because we can definitely report what’s happening. That’s indisputable. For example, instance, African American patients, regardless of gender do worse. They’re diagnosed later, and they do worse, stage for stage with whatever cancer that they have, including bladder cancer.

That part is not controversial. No one’s going to dispute that. The controversial parts, the two of them are, well, why is that the case? And then what do we do about it? If you look at stage for stage one might say, okay, well do certain ethnicities, are they predisposed to having worse cancers is the cancer themselves, the worse actors, more aggressive? Is it harder to handle? And then others will say, no, it’s the exact same cancer, but they’re just not getting as good care for whatever reason. I do think based on what we see that it is probably more of the latter, but I don’t want to ignore the former, I don’t want to then just dismiss the idea that certain groups, certain people might be predisposed to a worse version of the cancer, because then, maybe I don’t treat as aggressively, and therefore I’m not treating as appropriately.

So it’s a difficult one that we have to have an open mind to really difficult question that we have to have an open mind to truly address appropriately. Let’s tackle gender first. Okay, so independently of race. This is particularly interesting with bladder cancer, because women often can miss this diagnosis, can misreport the initial symptoms. They might be peri-menopausal or premenopausal or even postmenopausal, and they have just an occasional menses or just kind of used to seeing blood in the urine from time to time, and just kind of ignore that symptom. Whereas men see something like that, they’re right away, they’re going to go talk to a, speak to a physician, get that addressed. And I would urge all people to get that addressed, because it is abnormal to have blood in the urine period.

But women might miss it and miss that early diagnosis. Therefore, they’re diagnosed later, and therefore, there is a worse prognosis for women that have bladder cancer. Now stage for stage, it does not appear to be worse. So that does suggest that once it’s diagnosed, women and men are getting the same care, and their prognosis is pretty similar, okay? And that’s a good thing. But it does also say that women are…were missing this diagnosis in a lot of women. So, it’s definitely important to get checked out. Now as far as race goes, and this was an unfortunate finding in our research that we did, but it’s pretty glaring about twice as likely to get diagnosed at any later stage of bladder cancer if you’re an African American versus a non-African American, and I don’t have the why, the answers of why. But I can tell you based on the research that if you’re diagnosed later, certainly your prognosis is worse. Certainly, the chances of cure are worse, and the overall life expectancy is worse.

Is it possible that there might be some biologic components to this, regardless of when one was diagnosed? It is, but in our research we try to isolate these factors. So, for example, grade of tumor, which is the intrinsic aggressiveness of how the cancer might behave. We do tend to see a higher correlation in African Americans in high grade tumors. So, that does suggest that biologically there’s a component here that maybe confers a worse prognosis. However, we also did try to control for that as one of our variables in our multi-variable analysis, meaning we filter that part out, we accounted for that, and we still see that African Americans were diagnosed at a later stage and had a worse prognosis overall. So the answer is kind of a little bit of both when it comes to nature versus nurture type of thing. But at the end of the day, we do, unfortunately, see a worse experience for African Americans when it comes to bladder cancer.

Lisa Hatfield:

Okay. Thank you. And how about an [ACT]IVATION tip for this question?

Dr. Shaakir Hasan:

Yeah, so, it’s probably going to be a consistent theme here,  but if you see something abnormal, again, going back to the blood and the urine, please, get medical advice, please go, address this with your PCP. Again, it may be nothing, but it’s something that’s definitely worth investigating, because it literally could save your life. You do have to kind of be your own advocate if you do notice that you’re getting dismissed for whatever reason if you, because there might be a physician that says, oh, hey, you’ve stayed your period, don’t worry about it. You say, you know what, that’s fine, but I do want to get this checked out. This is abnormal. This just doesn’t happen to me. I do want to understand what’s going on here. So I would, you kind of have to be your own advocate sometimes.

Bladder Cancer Awareness: The Power of Early Detection

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What impact can early detection have on bladder cancer? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses the difference that early detection can make on bladder cancer prognosis, common symptoms, and proactive patient advice to ensure the best care.

[ACT]IVATION TIP

“…do not ignore something that feels off something that’s abnormal. Of course, blood while you’re urinating that’s just not a normal thing. Now, I want to make a special point here to just point out that women a lot of times, especially premenopausal women obviously go through menstruation cycles, and they might just say, oh, there’s some blood in the urine, probably from the period probably related to that, or it’s transient. It just comes and goes, and you don’t think about it too much. Do not ignore this, okay?”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

 Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

 When Is Immunotherapy Recommended in Bladder Cancer?

When Is Immunotherapy Recommended in Bladder Cancer?

Transcript:

Lisa Hatfield:

Dr. Hasan, what does it mean to be diagnosed with bladder cancer at an early stage versus a later stage?

Dr. Shaakir Hasan:

Great question. So, like any other cancer the earlier the diagnosis, the better the prognosis, the better the chance of cure. So, bladder cancer is one of these that we are fortunate enough to be able to detect early most of the time because you’ll present with symptoms, you’ll present with painless hematuria or just blood in the urine that doesn’t cause any pain. And as a result of that, that’s obviously not normal. A lot of patients will notice that and be alarmed by it, rightfully so, and they’ll seek medical attention. One thing leads to another, and hopefully they’ll see a urologist and ultimately get a cystoscopy  

and ultimately get that diagnosis of bladder cancer before it spreads, before it becomes invasive, before it becomes metastatic. And at that point, uncurable. So earlier the stage, the easier it is to cure, the better chances you have. So it’s a very big deal to be able to catch this early, and particularly because this is the type of cancer that you can catch early, unlike many other cancers where, unfortunately, we don’t detect it early enough, this is an opportunity to get it and cure it before it becomes a problem. So, it’s really important in this situation.

Lisa Hatfield:

Okay. Thank you. And do you have an [ACT]IVATION tip for that, Dr. Hasan?

Dr. Shaakir Hasan:

Definitely. So do not ignore something that feels off, something that’s abnormal. Of course, blood while you’re urinating that’s just not a normal thing. Now, I want to make a special point here to just point out that women a lot of times, especially premenopausal women obviously go through menstruation cycles, and they might just say, oh, there’s some blood in the urine, probably from the period probably related to that, or it’s transient. It just comes and goes, and you don’t think about it too much. Do not ignore this, okay? Look, it could be nothing. It could be related to menses, it could be maybe something else like a kidney stone that you don’t notice, something like that. But that also deserves medical attention. So anything that’s off, please do not hesitate. Go seek medical advice right away. Hopefully you’ll have a PCP that you can connect with, but if not even if you just go to an urgent care and you just get a urinalysis and they confirm it and they go, okay, well, let me take you to the next steps it’s really important thing to make sure you don’t ignore.