Have You Read?
By: Craig Niederberger, MD, FACS, College of Medicine and College of Engineering, University of Illinois at Chicago | Posted on: 20 Jul 2023
Vince RA Jr, Jiang R, Bank M, et al. Evaluation of social determinants of health and prostate cancer outcomes among Black and White patients: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(1):e2250416.
Special thanks to Dr Sophia Ford-Glanton at eviCore Healthcare.
The medical community unfortunately has not always held itself to the highest standards when it came to the care and treatment of ethnic minority patients. Medicine’s history with its most vulnerable populations is complicated at best. Recently, there has been much more emphasis and focus on identifying gaps or weaknesses and working to correct and improve. In the oncologic world, prostate cancer outcomes are still disproportionately worse for Black compared to White patients. In this article the authors evaluated if social determinants of health play a role in this disparity.
The authors identified 47 studies for their analysis. Interestingly, they observed that the number of studies published with comparative analysis of prostate cancer outcomes between races has increased in recent history, with over half of the studies being reported since 2011. They concluded that with all things being equal and with standardized treatment for all patients, Black men with prostate cancer have similar outcomes to their White counterparts. However, when social determinants of health were accounted for, Black patients fared worse. As physicians we must acknowledge how social determinants of health can impact our patient populations and be prepared to account for them so we can ensure that all of our patients achieve the best outcomes possible. Ideally, we will work to ameliorate the barriers that these social determinants erect, providing equitable care for all.
McElree IM, Steinberg RL, Mott SL, O’Donnell MA, Packiam VT. Comparison of sequential intravesical gemcitabine and docetaxel vs bacillus Calmette-Guérin for the treatment of patients with high-risk non-muscle-invasive bladder cancer. JAMA Netw Open. 2023;6(2):e230849.
Special thanks to Drs Marcin Zuberek and Simone Crivellaro at the University of Illinois at Chicago.
The COVID-19 pandemic introduced significant challenges including supply chain and production for bacillus Calmette-Guérin (BCG) for immunotherapy for nonmuscle-invasive bladder cancer, under strain even before the coronavirus pandemic. What other alternatives could be clinically effective, safe, and readily available?
These authors studied about 300 patients who were randomly assigned to receive one of 2 treatments, either BCG or docetaxel and gemcitabine intravesical therapy. They observed that sequential intravesical gemcitabine and docetaxel treatment was associated with a longer time to recurrence compared to BCG, with a median time to recurrence of about 25 months for the gemcitabine and docetaxel group vs about 17 months for the BCG group. The gemcitabine and docetaxel treatment was associated with a similar rate of treatment-related adverse events and having more patients finish the induction course compared to BCG.
BCG is currently the standard treatment for high-risk nonmuscle-invasive bladder cancer, but it is associated with a number of side effects and is often in short supply. The gemcitabine and docetaxel treatment could provide a viable alternative with potentially longer disease-free intervals for patients. This study also demonstrated better adherence to this alternative treatment. From chaos often comes innovation, and COVID-19 may have shown us a better treatment for high-risk nonmuscle-invasive bladder cancer than BCG.
Narang G, Moore J, Wymer K, et al. Effect of cannabidiol oil on post-ureteroscopy pain for urinary calculi: a randomized, double-blind, placebo-controlled trial. J Urol. 2023;209(4):726-733.
Special thanks to Drs Rabun Jones and Mahmoud Mima at the University of Illinois at Chicago.
Cannabinoid (CBD) products have demonstrated efficacy for treatment of chronic pain and for cancer patients with pain, but generally quality evidence about urological applications of CBD is limited. These investigators performed a prospective, double-blinded, randomized, placebo-controlled trial examining the effect of CBD on pain after ureteroscopy and ureteral stent insertion. CBD receptors are found throughout the urinary system and are thought to modulate smooth muscle contractility, so the idea was that CBD might be useful after ureteroscopy.
The authors randomized 90 patients to receive the Food and Drug Administration–approved CBD oral solution Epidiolex or placebo for 3 days after ureteroscopy and stent insertion. In addition to the oral solution, both groups received a standard postureteroscopy regimen including oxybutynin, tamsulosin, and phenazopyridine. The primary outcome was the maximum pain score on the visual analog scale on postoperative day 3, with secondary outcomes including the Ureteral Stent Symptom Questionnaire score, pain scores throughout the study, compliance with study drug, rescue narcotic usage, and postoperative complications. Ultimately, there was no significant difference between the primary outcome, nor were there significant differences between any of the secondary outcomes. In fact, the only significant difference was the incidence of dizziness on postoperative day 1, which was higher in the CBD group. Notably, the lowest available dose of the CBD solution was used in the study in order to minimize side effects, so perhaps an increased effect could be achieved with different dosing levels and regimens. As all urologists know, stent discomfort can be challenging, and controlling stent discomfort is advantageous for patients, their surgeons, and the health care system at large. While this well designed and executed study did not reveal a role for CBD after ureteroscopy for pain control, it’s a starting point.