Approximately 66.2% of patients with stage IV bladder cancer are not being treated with chemotherapy, a study published in Clinical Genitourinary Cancer found.1

Among 1215 patients aged 65 or older in the Surveillance, Epidemiology, and End Results (SEER)­­­­­­­­­­–Medicare database with a primary diagnosis of stage IV bladder cancer, 411 (33.8%) received chemotherapy treatment during the period of January 1, 2007 through December 31, 2011.

Although the study authors reported the treated patients incurred significantly fewer per-patient-per-month (PPPM) costs than untreated patients (P < .01), total health care costs for treated patients were more than twice the total costs for untreated patients ($139,893 and $66,829, respectively), which the authors attributed to an “approximate 4-fold increase in life expectancy for the treated patients.”1

Continue Reading

The study also highlighted that treatment with chemotherapeutics was linked to fewer PPPM health care visits (7.5 visits for those who were treated compared with 10.2 for those who were not treated), but also reported that over the full lifetime of patients, treated patients attended nearly 3 times the number of health-related visits compared with nontreated individuals (111.1 compared with 39.4, respectively).

Related Articles

There was a significant difference in survival between treated and untreated patients (13.2 months vs 3.2 months, P = .05). Based on the data from the study, the overall cost of the 10 additional months of survival was approximately $73,064.

The rate of drug treatment in patients with stage IV bladder cancer during the study period was 34%, which the researchers indicated was lower than the rates reported in earlier studies. Based on this finding, they concluded that increasing the percentage of treated patients in the described population could “potentially extend overall survival while simultaneously lowering PPPM costs.”

However, the investigators also acknowledged the “lower chemotherapy treatment rate in the current study might conceivably be related to differences in patient demographic and clinical characteristics,” suggesting the lower rate of treatment they observed could be tied to the specific characteristics of the patients in the SEER database, and may not represent a general treatment trend across all patients with stage IV bladder cancer during the study period. The researchers added, “the SEER­­­­­­­­­­–Medicare database does not provide a rationale for why individual patients were not treated with chemotherapy.”

Disclosures: The study was supported by Merck & Co Inc. Please refer to the original paper for a complete list of disclosures.


  1. Flannery K, Cao X, He J, Zhong Y, Shah AY, Kamat AM. Survival rates and health care costs for patients with advanced bladder cancer treated and untreated with chemotherapy. Clin Genitourin Cancer. 2018;16(4):e909-e917.