What Is Community Oncology?
Community oncology describes private, physician-owned, independent oncology practices found in urban, suburban, and rural areas all over America. These clinics are not part of a teaching institution or hospital and can vary in size and scope. Some community oncological care practices may consist of one oncologist’s office. Others consist of several distributed offices run by a group of physicians. Their support staff may include nurses, physician’s assistants, technicians, radiologists, and pharmacists. Community oncological practitioners serve more than half of all cancer patients in the United States. Community oncology clinics treat cancer patients just like any other oncology clinic would and they treat all kinds of cancer like cervical, breast, bladder cancer, etc.
What Role Does Community Oncological Care Play in Treating Bladder Cancer?
In the United States, bladder cancer is the sixth most commonly diagnosed cancer. About 80,000 cases of this type of cancer are diagnosed annually, and tens of thousands of people die from the disease yearly. It is most commonly experienced by white men aged 55 and older, but the disease also affects many underserved populations, including women and people of color.
Community oncological care clinics reduce disparities in bladder cancer care by providing access to cost-effective, high-quality treatment in areas where the cancer is less frequently diagnosed. Geographical health disparities occur because bladder cancer treatment requires access to specialists. Travel costs, long wait times, late-stage diagnoses, and a lack of follow-up can also create barriers to care. Underserved patients are less likely to be properly evaluated or treated for it. Still, culturally competent healthcare professionals can help patients become more knowledgeable, share decision-making with their providers, and stay engaged in their treatment.
What Role Does Community Oncological Care Play in Bladder Cancer Support?
Community oncological practices often provide pharmacy services and integrated care within a single facility. Doctors, surgeons, nurses, radiologists, and medical assistants may all be available on-site, depending on the scope of the practice. Patients who utilize community oncological care centers may experience fewer delays in treatment, personalized care, and better long-term support.
What Are the Current Treatment Options for Bladder Cancer?
Depending on the stage, severity, and location of the cancer, treatments can include bladder cancer surgery, intravesical immunotherapy or chemotherapy, systemic chemotherapy, radiation therapy, and other treatment modalities. A few of these care options are discussed below:
Bladder Cancer Surgery
Most treatments involve surgical intervention. The procedure and side effects will vary based on whether the cancer is superficial or if it manifests in the muscle layer of the bladder wall. The most common types of bladder cancer surgery are transurethral resection of the bladder tumor (TURBT), partial cystectomy, and radical cystectomy.
Transurethral Resection of Bladder Tumor (TURBT)
Most superficial early-stage bladder cancers are treated with TURBT, which removes abnormal or cancerous cells, tumors, and adjacent tissues from the bladder wall. No incisions are made, but an instrument must be inserted through the urethra to remove the cells. Patients receive general or regional anesthesia before surgery. After removing the tumor, doctors may ensure the cancer has been completely destroyed by burning surrounding tissue in a process called fulguration.
Patients who suffer from invasive cancer that affects the bladder’s muscle wall may undergo a cystectomy, an operation that partially or completely removes their bladder. The patient typically receives chemotherapy before the operation, which takes place under general anesthesia.
When this kind of cancer has spread to the muscle layer of the bladder wall but remains localized in a small area, the cancer, the affected part of the bladder wall, and the adjacent lymph nodes can be surgically removed. The bladder wall is then stitched closed so the patient can keep their bladder without reconstructive surgery. If cancer recurs in another part of the bladder wall, the organ may have to be removed entirely.
A radical cystectomy is a significant operation that removes the entire bladder and nearby lymph nodes. It also involves removing the prostate and seminal vesicles in men or the ovaries, fallopian tubes, uterus, cervix, and a portion of the vagina in women. Cystectomy is done by cutting into the abdomen or performing laparoscopic surgery. Reconstructive surgery is required after a radical cystectomy to allow urine to pass out of the body.
Intravesical therapy involves flooding the bladder with a liquid immunotherapy or chemotherapy treatment administered via a urinary catheter. It is used to treat superficial, early-stage bladder cancers that affect only the inner lining or the layer just below the bladder’s inner lining. The medication has little effect on cells beyond the treatment site.
Intravesical immunotherapy treatments encourage the body’s own immune system to destroy cancer cells. The most common intravesical immunotherapy for treating early-stage bladder cancer is Bacillus Calmette-Guerin (BCG) germ therapy. Nadofaragene firadenovec (Adstiladrin) is an alternative gene therapy treatment that uses a virus to make interferon alfa-2b, a protein that helps the body’s immune system overcome cancer. These treatments are not usually given to people with weakened immune systems.
Intravesical chemotherapy involves administering chemotherapy drugs like mitomycin, gemcitabine, or valrubicin via a catheter into the bladder to kill growing cancer cells. It is typically used after intravesical immunotherapy fails. The drugs usually stay in the bladder, which can help prevent side effects.
Intravesical therapy is often used within 24 hours after a TURBT procedure to ensure that all cancer cells are destroyed. Low-risk cancers may not require additional treatment, while higher-risk patients may receive periodic therapies for several years.
Additional Bladder Cancer Procedures and Treatment Modalities
Systemic chemotherapy, radiation therapy, targeted drug therapy, and complementary and alternative treatments, including herbs, vitamins, and special diets, may also be used as bladder cancer options to treat or relieve oncological symptoms. Complementary treatments are used alongside traditional medical care. To make informed treatment decisions, bladder cancer patients must work with their care teams.
Community Oncological Care Promotes Better Cancer Care
Community oncological practices are key to treating bladder cancer in underserved communities. These practices can help patients experience better access to the cancer treatments they need and achieve positive long-term outcomes.