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.”

See More from [ACT]IVATED Bladder Cancer

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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

 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.

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

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Bladder cancer disparities have been examined for several decades. Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses patient groups that show disparities and patient advice to advocate for optimal care.

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

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

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

 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, what are the most significant disparities that you’ve observed in the treatment of bladder cancer among different demographic groups?

Dr. Shaakir Hasan:

Yeah, so you know, unfortunately, we did find, and actually, before I even start, let me preface this by saying there was a study done about three decades ago, the early ‘90s, that looked at the diagnosis and prognosis of bladder cancer patients in the ’60s, ’70s and ’80s. And they found that there was a worse prognosis for African Americans, particular other minorities, but mostly African Americans, both when it comes to diagnosis, like they were diagnosed later, and then their outcomes, they had worse survival, worse cure rate. And I’m sorry to say that we repeated the study, they use theory data. It’s a national database, and we use the National Cancer Database, NCDB to do a similar study, looking much later. So we did this a few years back. And so we’re looking at the 2000s, 2010s, up to 2020.

Unfortunately, we actually found the same results. The overall prognosis is better, because the overall treatment and management is better. But the differences, unfortunately, still remain. So, Black patients were almost twice as likely to be diagnosed in later stages, i.e., stage IV, incurable stages than their white counterparts. And that obviously means that they’re going to, there’s going to be worse outcomes when it comes to cure rates and survival, overall survival. And so we still do see that today.

Lisa Hatfield:

Okay. Thank you for that information. I also have a follow-up question to that, because I read your study a little bit and learned a little bit more about some of the factors that lead to a later diagnosis. So if you have a patient sitting in front of you who is afraid maybe to, maybe they’re going in, they have blood in their urine, which is a symptom, could be a symptom of bladder cancer. Their PCP has told them originally, well, it might just be, you might be on your period, it could be something else, they go in once or twice, a patient is afraid to confront their doctor or say, you know, is there any way we can follow up on more, maybe they don’t want to offend their doctor, maybe they’re just afraid to do it. Do you have any piece of advice for that patient, just so they don’t get diagnosed in a later stage, if that is the reason why they might be diagnosed later, what would your advice be to that patient sitting there?

Dr. Shaakir Hasan:

Yeah, totally. So I think one would be surprised. First of all, never worry about offending your doctor. You know, that’s one thing that I start with. And it’s, and I say that a little tongue in cheek, but I actually mean that because there have been plenty of times where your doctor’s not trying to be dismissive, right? They’re not trying to just, obviously, you never want to be the one that missed something. You never want to be the one that bladder cancer, right?

And so you might just not be thinking about something at that moment, you might really be sitting there and going, oh, look, it’s very likely not this because I know my list of diagnoses. And I know like, what’s more common and what’s not, that’s part of my job. And so it’s not so much, you know, the attempts to offend or miss something. But the second you bring it up, the second that you advocate for yourself, far more likely, we’re far more likely to act on it.

And that’s just kind of a universal principle. There might be something that they missed, there might be, maybe you’re perimenopausal, and you haven’t had menses in a couple years, and the doctor just missed that. There could be something that you, you know your body, you should advocate for yourself in those situations, do not worry about offending, because honestly, you’re not like, I can’t really imagine I couldn’t, I’ll admit, there definitely been times where someone asked about something that I wasn’t thinking about, not intentionally. And I just Oh, yeah, of course, we’ll look into that. There’s no offense, you know, taken. So I wouldn’t worry about that.

And even if they were offended, this is your body, it could be life or death, you shouldn’t worry about that. The second thing I want to mention, though, is that, you know, it’s probably not as likely that everyone is seeking medical care, and then one is just being dismissed certainly is possible. Certainly, we do have evidence of that happening, and unfortunately in different situations, but it’s probably more a reflection of certain people will have primary care and certain people just don’t.

If you don’t have insurance, for example, you’re not as likely to go have a routine checkup. And these routine checkups, they’ll check the urine, they’ll do urinalysis, and you might not notice blood in the urine, but they can tell it microscopically. But if you’re not routinely doing this, as a screening process, then you’re not going to detect it. And so I think one recurring theme in healthcare in general is just preventive medicine. And I think that we really have to work hard to implement that for all groups. And certainly, there’s a disproportionate lower primary care coverage of certain minorities and socioeconomic groups that we really have to do better at. And I think that will translate into detecting more bladder cancer earlier for whatever ethnic group you want to.

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

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In navigation of bladder cancer treatment, what role do academic and community centers take? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses efforts that have been taken to bridge the gap between academic and community care, goals of collaborative care, and proactive patient advice.

[ACT]IVATION TIP

“…do your own research. But don’t be so kind of close-minded to think, oh, academic center, that’s going to be the best quality care community center, that’s going to be subpar. No, dig a little bit deeper, ask specifically, what do you offer and try to do a little bit of your own research and say, is there bladder preservation? Is there immunotherapy? Do you offer clinical trials, and then kind of go from there.”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

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

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

 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, what role do academic centers play in the treatment of bladder cancer, and why might patients at these centers receive different care compared to those at non-academic centers?

Dr. Shaakir Hasan:

So, the kind of “good answer” here is that they shouldn’t. There really shouldn’t be a difference in care. And I do think having been at many different types of institutions to the hardcore academics to community centers in rural communities, I have seen this transformation of, it used to be where you get the best care at these academic centers, and then you get very mediocre care at the rural communities. And they’ve made a conscious effort all throughout the country to bridge that gap.

And I think they’re doing a really good job, because you’ll like to see a lot of centers that will kind of bring everyone together and centralize the treatment, and then just kind of teach or kind of distribute the treatments the same way at other places. And I’ll also tell you that a lot of physicians are really good at what they do. A lot of times, the limitations are the resources, not so much skills or capabilities of a clinician.

So I would say as a patient, don’t be if you’re out in a rural community or a community center, don’t let that scare you or think that you’re going to get inadequate treatment, just because of that but do ask about the resources, do ask about the capabilities. If you’re in a radiation clinic, ask about the technology. If you’re in a medical oncology clinic, ask about immunotherapy and what’s available in clinical trials, et cetera. Now the question of academic centers is actually quite interesting because if you look at our research, if you look at the study that we did on bladder cancer, for example, you see that there is kind of a worse outcome at academic centers.

Now that’s not because, I don’t think that that’s because they’re doing a worse job. It’s just that patients tend to send more complicated cases to those centers, right? And so this is one of those, you know, correlation, not cusation things. And so if you look at the outcomes, you’re going to see probably worse outcomes at academic centers just because there are more complicated cases.

But if you try to isolate that, you know, stage for stage, we have to see that the results are quite similar, thankfully, alluding to kind of what I mentioned before, that the care should be starting to equalize among centers. And so I think that that’s kind of where we’re heading. What I do think academic centers might offer more so than communities is just specialized care. So if you have a urologist that all they do is bladder cancer, that’s all they do all day, that’s probably going to be someone that you want to seek out. And you know, I think a lot of urologists in the communities will say, “Hey, you got to go check out this person who only does bladder cancer.” And I think hopefully they’ll, you know, they’ll have that appropriate kind of referral pattern.

But on the other hand, there is something…there are other very simple procedures that anybody can do. And you should feel, you know, you should feel comfortable getting that done in the community. For radiation, I can tell you that there might be some specialized physicians that are only doing GU, and they have a bladder preservation program that might be done differently, implemented differently at an academic center than in the community.

But I’ll also say also caution patients, you know, there also may be some academic centers, and I’ve been at them that don’t have a program at all for bladder preservation. But there are some of the communities that do. So I think my kind of [ACT]IVATION tip here is do your own research. But don’t be so kind of close-minded to think, oh, academic center, that’s going to be the best quality care community center, that’s going to be subpar. No, dig a little bit deeper, ask specifically, what do you offer and try to do a little bit of your own research and say, is there bladder preservation? Is there immunotherapy? Do you offer clinical trials, and then kind of go from there.

Lisa Hatfield:

Okay. Thank you. That’s a great [ACT]IVATION tip. And I also like that you mentioned seeking out a specialist, I’m a huge advocate for that. I don’t have bladder cancer, I have another kind of cancer. But even if it’s just for an initial consult, or for a consultation about treatment, talk to somebody who deals with that on a very regular basis, or maybe exclusively, so thanks for that comment.

Dr. Shaakir Hasan:

And actually, I’ll follow up on that and also say, you know, sometimes it’s worth it just to get that opinion, and then have them help direct the care and be involved in your care. And they can always go back and say, “Oh, hey, let me talk to your local oncologist. I know you live 10 miles away from your local oncologist, you live three hours away from me. But we can still get you the same care, we’re going to be in communication, you’ll get my input, and then we’ll take care of you.” So yeah, it’s definitely more of a collaborative effort these days. And it’s for the better.

When Is Immunotherapy Recommended in Bladder Cancer?

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Bladder cancer immunotherapy is available, but which patients qualify for it? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses who is eligible for immunotherapy, patient factors that contraindicate against immunotherapy, and proactive patient advice to learn about immunotherapy. 

[ACT]IVATION TIP

“…ask about it just to ask your provider what’s going on with the immunotherapy? Any board-certified oncologist should be able to address it.”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Bladder Cancer Awareness: The Power of Early Detection

Bladder Cancer Awareness: The Power of Early Detection

 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

Transcript:

Lisa Hatfield:

Dr. Hasan, how do you determine which patients facing a bladder cancer diagnosis are suitable candidates for immunotherapy?

Dr. Shaakir Hasan:

Right now you don’t really want to be a suitable candidate for immunotherapy, because right now it’s indicated for those that have metastatic disease not curable disease. And they’re now doing, they’re doing clinical trials and to test immunotherapy in localized, curable disease. And I suspect we’re going to, it’s going to pan out. It’s going to be better than just classic chemo. But right now, you don’t want to be in that category. Now, if you do happen to be in that category, if you happen to have metastatic disease or incurable disease, there’s nothing that would stop you other than what we call contraindications, meaning specific conditions that prevent you from getting a treatment, because it can cause harm. But other than that, there’s nothing that should preclude you from getting immunotherapy.

And also the combination of an anti-drug, antibody drug conjugate to get the most optimal treatment. Sometimes because it does ramp up the immune system, you end up having, as a side effect, you can have what we call autoimmune conditions because the immune system is so ramped up, it can not only attack these cancer cells, but also attack your healthy tissue in a way we don’t want to. And that can adversely affect you.

So you can have what we call the itises, the inflammatory effects of different organs. Pneumonitis is inflammation of the lungs, colitis is inflammation of the colon, just to name a couple. And that can be problematic. So if you’re predisposed of these conditions, if you already have autoimmune conditions, then you might be more susceptible to what immunotherapy can cause and that might be a contraindication. But otherwise there really should be no reason you couldn’t get immunotherapy, and it’s definitely worth having a conversation with your oncologist.

Lisa Hatfield:

Okay. Thank you. So you talked about the contraindications for that, but are there any specific biomarkers of bladder cancer or characteristics of the cancer itself that influenced that decision for immunotherapy?

Dr. Shaakir Hasan:

So classically, we look at, what we call PD-L1, and that’s the ligand. It’s the protein on the cells that that’s expressed at a certain rate. That’s what the immunotherapy binds onto to initiate this cascade, which it heightens the immune system. And so some of these cancer cells have a higher expression of that protein, and therefore will be more susceptible to it. So we classically kind of look at that expression and then correlate that with your, how well you would do with immunotherapy. However, there are many instances, for example, lung, head, and neck and bladder, where it doesn’t even matter independently of the expression of the PD-L1. You can still benefit from it. Now you might benefit to a different degree, but in this case, we would recommend it regardless of your PD-L1 status.

Lisa Hatfield:

Okay. Great. Thank you, do you have any [ACT]IVATION tips for the immunotherapy question?

Dr. Shaakir Hasan :

I would just say, again, if it’s not mentioned at all, that’s a little strange. Particularly in the metastatic setting, you should always bring it up to your provider, at any stage. Like I said, right now it’s indicated FDA-approved in the metastatic stage, but in any capacity, it should be something that’s addressed by your oncologist. So I would simply, as an [ACT]IVATION tip, ask about it just to ask your provider what’s going on with the immunotherapy? Any board-certified oncologist should be able to address it.

Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

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Bladder cancer treatment has some new options for patient care. Expert Dr. Shaakir Hasan from Beth Israel Lahey Health shares an overview of the latest treatment options, how they work against bladder cancer, access to the treatments, and proactive patient advice to help ensure optimal care. 

[ACT]IVATION TIP

“…don’t kind of settle for just if they just give you one approach and that’s it, they don’t mention anything else. You’ve got to question that a little bit. But the vast majority of providers will at least tell you…acknowledge that there are other options out there.”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Bladder Cancer Awareness: The Power of Early Detection

Bladder Cancer Awareness: The Power of Early Detection

 Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

 When Is Immunotherapy Recommended in Bladder Cancer?

When Is Immunotherapy Recommended in Bladder Cancer?

Transcript:

Lisa Hatfield:

Dr. Hasan, can you provide an overview of the latest treatment options for advanced bladder cancer, and in particular, the role of immunotherapy and how it works to treat bladder cancer?

Dr. Shaakir Hasan:

Absolutely. So this is a really exciting time in bladder cancer treatment because for a couple reasons. I’d say there are two kind of main frontiers. I’ll address the immunotherapy first. So for the longest time, we were treating bladder cancer, particularly metastatic bladder cancer, i.e., Incurable bladder cancer with platinum-based chemotherapy. So chemotherapy is cytotoxic, meaning it goes, and it’s all throughout your body. It’s systemic, and it kind of kills everything. It attacks everything. Tumor cells are more susceptible to this type of treatment because they have high cell turnover, and as they turn over, they’re more exposed. Your DNA is more exposed to these mechanisms of cell kill. And so they’re differentially affected, but it still does a number on the rest of the healthy tissue in your body. Immunotherapy is newer, and it’s a type of treatment that inhibits the inhibition of your own immune system.

In other words, it helps the immune system work better. And that’s important, because the immune system is one of the main tools in fighting cancer. It does recognize these cancerous cells as not necessarily foreign, but abnormal cells that shouldn’t be there. And so it does help your body attack those cells. And when it does that, it’s more selective than the cytotoxic classic chemotherapy that we use. And so we’re adopting this immunotherapy in more and more cancers. Bladder is one of them, and just, I want to say in the past six months, they had a really big study that compared classic platinum-based therapy to a combination of pembrolizumab (Keytruda) and enfortumab vedotin-ejfv (Padcev), which it’s called an antibody drug conjugate, an ADC. It’s another mechanism that it works in conjunction with immunotherapy to kind of better isolate these tumor cells to destroy them.

And that showed a dramatic increase in survival and disease control compared to classic chemotherapy. So, that’s doing really well, and we hope to see that more earlier in more curable stages of disease as well. So that’s an exciting frontier. The other aspect I would say is we’re seeing more and more bladder preservation. Now, I’m a radiation oncologist. I might be biased in this topic, but historically we’ve always treated curable bladder cancer with a combination of chemotherapy and surgery. So you remove the bladder in its entirety, you remove the cancer with it, and then you give systemic therapy to prevent any stragglers, we’ll call them cancer cells that are just left behind.

And this has been effective, but of course you lose your bladder. And so this is some at the end of the day, if you can preserve it, if you can preserve the organs you were born with, you want to do that. And if you, instead of doing a cystectomy, which is removal of the bladder, if you do a combination of chemotherapy and radiotherapy, and probably in the future immunotherapy altogether, you can have the same chances of cure, same chances of survival, but preserve the bladder. So we’re seeing that more and more these days.

Lisa Hatfield:

Okay, thank you. I do have a follow-up question to that also. So if a patient’s watching this maybe lives in a smaller community, doesn’t live near a big academic center, are these immunotherapies in clinical trials only, or are they being used at more local centers? And then also for things like radiotherapy how about that type of therapy also, can they access that at their local cancer center?

Dr. Shaakir Hasan:

Great question. So immunotherapy at this point really should be everywhere. It really really should be everywhere. It should not be difficult to access, whether you’re in a rural community or in a big level four academic center. Radiation can be more variable, not because of the access, because frankly, you should be able to find a radiation oncology clinic within I don’t know, a half-hour of anywhere that you are in the country there are enough of those clinics in the country. However, it just varies place to place as to the types of treatments that they’re comfortable doing. And also as an institution it is a multimodality approach. You have to have a urologist to buy in. You have to have the medical oncologist to buy in and the radiation oncologist to buy in. And that can just change institution to institution.

In either scenario, when it comes to an [ACT]IVATION tip, I would say do not settle for what’s offered to you if you know that these other options are available. So, you do a simple Google and you find out what are the treatment options available, and then you just mention them to your local oncologist. And the vast majority of them, whether they provide them or not, will tell you, oh yeah, that is an option. We don’t do that here, but please check out these other places. And, so don’t kind of settle for just if they just give you one approach and that’s it, they don’t mention anything else. You’ve got to question that a little bit. But the vast majority of providers will at least tell you…acknowledge that there are other options out there.

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…”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Bladder Cancer Awareness: The Power of Early Detection

Bladder Cancer Awareness: The Power of Early Detection

 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, 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?”

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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.