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Study: Bladder cancer patients get 'crummy care'
July 11th, 2011
12:00 PM ET

Study: Bladder cancer patients get 'crummy care'

Patients with aggressive non-invasive bladder cancer aren't getting the care they need, according to a study published Monday in the online journal Cancer.

Researchers at UCLA's Jonsson Comprehensive Cancer Center found 99% of patients with high-grade bladder cancer that had not reached the muscle weren't getting the recommended follow-up care.

According to medical billing records from 4,545 patients, only one patient got the recommended cancer care says Dr. Karim Chamie, lead author of the study.  He says he considered every recommended treatment regimen and was very lenient and inclusive as to how doctors interpreted specific treatment and surveillance options.

Chamie says it's not a surprise to experts that bladder cancer patients get "crummy care." Dr. Stuart Wolf, a urologist and chair of the practice guidelines committee for the American Urology Association, agrees that not enough is being done by urologists, but he says "the article overstates the degree of noncompliance."

"There is something wrong, whether it's a patient factor, or whether it's a doctor factor is unclear," says Dr. Nicholas J. Vogelzang,  chairman of the Cancer Communications Committee of the American Society of Clinical Oncology. He suggests some urologists aren't taking this type of cancer diagnosis seriously and neither are their patients.

"Urologists have to be more vigorous and enforce their guidelines more," he adds.

Dr. Gary D. Steinberg, who specializes in urology oncology at the University of Chicago Medical Center, agrees. "You've got a significant unnecessary death rate from bladder cancer due to our lack of following well established guidelines."

Although he sees that some urologists are improving their follow-up, says Steinberg, he finds the majority are all over the place with their treatment practices. He believes the health care system in the United States is also partially to blame. "I really do think the overall reimbursement rate to take care of bladder cancer patients is not sufficient."

The study suggests patients need to be more actively involved in their treatment plan. "This is a cancer - if it's high-grade, that has a very high risk of progressing to invasive disease, which can affect your quality of life," says Chamie. "It is up to you the patient to take ownership of your cancer diagnosis, to arrange a strict surveillance and treatment schedule because at the end of the day it's the patient that has to live with their cancer diagnosis."

Wolf says patients should always be questioning their doctor about what's being done and why. "We definitely want to empower patients," he adds. Steinberg suggests patients refer to the Bladder Cancer Advocacy Network for more information.

Dr. H. Barton Grossman, deputy chairman of urology at the M.D. Anderson Cancer Center, also believes, like the AUA spokesman, that the study overstates the number of patients who don't get the proper treatment.

"It's good that they raise the issue but it's not as bad as they say," he says. Grossman, who was not involved in the study, suggests that urologists and patients need to be better informed but that "it's not 99% of the population not being adequately treated." He believes the number is more like 25% of patients and he acknowledges more needs to be done to educate doctors and patients with this prognosis.

"There are different sets of guidelines out there," says Grossman and it can be confusing because none of them are completely the same. Grossman is referring to guidelines from the American Urology Association, the European Association of Urology, and the National Comprehensive Cancer Network.

The study authors suggest the standard guidelines need to be more clearly defined and adhered to.  They suggest they should include:

– Check-ups every three months
– Injecting a cancer-killing drug directly into the bladder
– immunotherapy called BCG
– A cystoscopy (looking at the inside of the bladder & urethra with a scope)
– A urine test to look for abnormal cells


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Official definitions recommend that depressive disorders, additionally known colloquially as anxiety, are characterized by: unexpected depression of a person's mood, in the adverse instructions, of modest to solid intensity of the intensity of the skilled changes, for greater than a few weeks. There might be several reasons for the occurrence of modifications. It likewise takes place that it is hard to recognize any unequivocal factor. We very commonly come across the declaration that it is a people illness of the 21st century – it affects both older and also more youthful individuals. Our education is trivial for anxiety, let alone our revenues – it can influence anyone. Treatment of anxiety comes down to: pharmacotherapy, psychiatric therapy and also psychoeducation, photo-therapy, electroconvulsive therapy and even more all-natural tasks associated with the surge of exercise as well as the intro of considerable modifications in the everyday diet plan. It is as part of all-natural techniques of fighting as well as combating depression that the incorporation of cannabis preparations with cannabinoids naturally occurring in the plant in the everyday diet is obtaining increasingly more popularity on the planet. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, appears in countless clinical researches as a potentially effective cannabinoid in the therapy of depression. Significantly, it is a 100 all-natural chemical compound of plant origin. Remarkably, depression is among the three most common mental disorders in which individuals resort to CBD hemp prep work such as CBD oil, complete spectrum hemp oil with CBD or CBD capsules. Reports from customers and their favorable point of views on the efficiency of e.g. CBD oil or full range hemp oil with natural CBD are growing at an extraordinary speed. 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Official interpretations suggest that depressive problems, additionally known informally as clinical depression, are defined by: sudden anxiety of an individual's state of mind, in the negative instructions, of moderate to strong strength of the intensity of the seasoned changes, for more than a couple of weeks. There may be several reasons for the event of modifications. It additionally takes place that it is difficult to determine any indisputable reason. We very frequently come across the declaration that it is a human being condition of the 21st century – it affects both older as well as more youthful individuals. Our education is not important for depression, let alone our incomes – it can affect any person. Therapy of clinical depression comes down to: pharmacotherapy, psychiatric therapy and psychoeducation, photo-therapy, electroconvulsive therapy and even more all-natural tasks related to the climax of exercise and the intro of significant changes in the daily diet plan. It is as part of natural approaches of fighting as well as combating clinical depression that the addition of marijuana prep work with cannabinoids naturally occurring in the plant in the everyday diet regimen is getting an increasing number of appeal worldwide. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, appears in countless scientific studies as a potentially efficient cannabinoid in the treatment of depression. Importantly, it is a 100 all-natural chemical substance of plant origin. Surprisingly, clinical depression is among the three most usual mental disorders in which individuals turn to CBD hemp preparations such as CBD oil, full spectrum hemp oil with CBD or CBD capsules. Reports from customers as well as their favorable opinions on the performance of e.g. CBD oil or complete range hemp oil with all-natural CBD are growing at an unmatched rate. 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Therapy of clinical depression comes down to: pharmacotherapy, psychotherapy and also psychoeducation, phototherapy, electroconvulsive therapy as well as even more natural tasks associated with the intensification of exercise and the intro of considerable changes in the everyday diet regimen. It is as part of natural techniques of battling and combating clinical depression that the incorporation of marijuana prep work with cannabinoids naturally occurring in the plant in the day-to-day diet regimen is getting an increasing number of popularity worldwide. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, shows up in various scientific researches as a possibly reliable cannabinoid in the therapy of clinical depression. Importantly, it is a 100 natural chemical substance of plant beginning. Remarkably, depression is among the 3 most usual mental disorders in which individuals resort to CBD hemp prep work such as CBD oil, complete spectrum hemp oil with CBD or CBD pills. Reports from customers and their positive opinions on the effectiveness of e.g. CBD oil or full spectrum hemp oil with all-natural CBD are growing at an extraordinary rate. THC and CBD cannabinoids – distinctions The key cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). They show antagonistic results, which indicates that CBD reduces the results of THC. What are these results? THC has an envigorating impact, causes a feeling of ecstasy, impacts cognitive features, however also unwinds. Big, routinely taken in doses of THC are thought about hazardous to the human mind. Extreme consumption of THC can cause psychosis, absence of inspiration, as well as even long-term adverse adjustments in cognitive feature. Both THC as well as CBD affect the endocannabinoid system in the human body. Their action, as currently stated, is contradictory. Cbd-a-thc-in-the-endocannabinoid-1 system When creating pictures, CBD slows down the deficiency of anandamide sources, and also THC accelerate this procedure. However, this does not suggest that THC is only a dangerous cannabinoid and also ought to not remain in the preparation in any way. However. Its tiny presence in hemp preparations is also necessary in order to obtain the supposed impact. harmony. THC in full range hemp oil exists in such a low and also, importantly, legal amount. This amount is so little (less than 0.2) that it does not create intoxication. Working together, THC and CBD have higher potential than either molecule performing alone. What is anandamide (AEA)? What is its significance for people dealing with anxiety? Continue reading! CBD, Anxiety and also the endocannabinoid system The endocannabinoid system is a vital system responsible for the policy of fundamental human physiological processes, such as power administration, neurohormonal and neuroimmune links, motor activity, state of mind as well as inspiration, and also fat metabolic process. The endocannabinoid system consists of a neurotransmitter called anandamide (AEA). Anandamide is a natural chemical that is normally produced in the human mind. Its manufacturing is promoted by e.g. physical activity, and to a minimal level by the supposed collaborate with the body (massage!). Its resources are "used" to preserve the correct performance of the body, including in the field of mental health and wellness. As shown in this study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high degrees of anandamide are associated with a lowered risk of developing psychotic signs. A high level of anandamide is also associated with a favorable effect on the decrease of depression and also anxiety signs. This device is still not fully understood, yet it seems sensible that a highly clinically depressed state of mind in a private time period for a certain case, and with the synchronised absence of activities targeted at its renovation, brings about a concentration of the increase of adverse thoughts. As depressive conditions develop, they can become even more unsafe forms of conditions, e.g. psychosis, deceptions or schizophrenia. Reducing this procedure as swiftly as feasible may end up being critical in the efficient treatment of mental illness of human performance.

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Main interpretations recommend that depressive problems, likewise known colloquially as depression, are identified by: abrupt anxiety of an individual's state of mind, in the adverse direction, of modest to strong intensity of the strength of the skilled adjustments, for greater than a few weeks. There may be several factors for the incident of adjustments. It likewise occurs that it is difficult to determine any kind of absolute factor. We extremely often found the declaration that it is a civilization condition of the 21st century – it influences both older and also younger individuals. Our education and learning is trivial for depression, not to mention our incomes – it can impact any person. Treatment of clinical depression boils down to: pharmacotherapy, psychiatric therapy and psychoeducation, phototherapy, electroconvulsive therapy as well as even more all-natural activities associated with the rise of physical activity as well as the intro of significant adjustments in the everyday diet regimen. It is as part of all-natural techniques of battling and also neutralizing anxiety that the inclusion of marijuana prep work with cannabinoids naturally occurring in the plant in the day-to-day diet is getting an increasing number of appeal on the planet. Cannabidiol CBD, found in e.g. CBD oil or full-spectrum hemp oil, appears in countless scientific researches as a possibly efficient cannabinoid in the therapy of anxiety. Importantly, it is a 100 natural chemical compound of plant beginning. Surprisingly, clinical depression is amongst the 3 most common mental disorders in which patients resort to CBD hemp preparations such as CBD oil, complete range hemp oil with CBD or CBD capsules. Records from consumers as well as their positive viewpoints on the performance of e.g. CBD oil or complete spectrum hemp oil with all-natural CBD are expanding at an unprecedented speed. THC and also CBD cannabinoids – differences The key cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). They show antagonistic impacts, which indicates that CBD minimizes the results of THC. What are these effects? THC has an envigorating impact, causes a sensation of ecstasy, affects cognitive functions, but likewise loosens up. Large, routinely eaten dosages of THC are taken into consideration harmful to the human mind. Excessive consumption of THC can bring about psychosis, lack of inspiration, and also also permanent unfavorable modifications in cognitive function. Both THC as well as CBD impact the endocannabinoid system in the human body. Their action, as currently pointed out, is contradictory. Cbd-a-thc-in-the-endocannabinoid-1 system When creating pictures, CBD slows down the depletion of anandamide resources, as well as THC quicken this procedure. Nonetheless, this does not mean that THC is only a dangerous cannabinoid and should not remain in the prep work in all. On the contrary. Its tiny presence in hemp preparations is even required in order to acquire the so-called effect. harmony. THC completely range hemp oil exists in such a marginal and, notably, legal amount. This amount is so little (less than 0.2) that it does not create drunkenness. Interacting, THC and CBD have greater potential than either particle acting alone. What is anandamide (AEA)? What is its value for people experiencing clinical depression? Continue reading! CBD, Clinical depression as well as the endocannabinoid system The endocannabinoid system is a key system in charge of the guideline of standard human physiological procedures, such as power management, neurohormonal and neuroimmune links, motor activity, mood and motivation, and fat metabolic process. The endocannabinoid system includes a natural chemical called anandamide (AEA). Anandamide is a natural chemical that is normally created in the human brain. Its production is promoted by e.g. physical activity, as well as to a minimal extent by the supposed deal with the body (massage therapy!). Its sources are "utilized" to preserve the appropriate functioning of the body, including in the field of mental health. As received this research study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high levels of anandamide are connected with a decreased danger of creating psychotic signs and symptoms. A high level of anandamide is also related to a favorable impact on the decrease of depression as well as anxiety signs. This mechanism is still not totally comprehended, but it appears rational that a highly depressed state of mind in a specific time period for a certain instance, and with the synchronised absence of activities focused on its improvement, causes a rise of the influx of unfavorable thoughts. As depressive disorders establish, they can become a lot more harmful kinds of conditions, e.g. psychosis, deceptions or schizophrenia. Reducing this process as rapidly as possible may become crucial in the effective treatment of mental illness of human functioning.

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Records from consumers and their positive viewpoints on the performance of e.g. CBD oil or full spectrum hemp oil with all-natural CBD are growing at an unprecedented rate. THC as well as CBD cannabinoids – distinctions The key cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). They reveal antagonistic results, which indicates that CBD minimizes the impacts of THC. What are these results? THC has an intoxicating impact, causes a feeling of euphoria, influences cognitive features, yet additionally unwinds. Huge, on a regular basis consumed dosages of THC are thought about harmful to the human brain. Excessive usage of THC can cause psychosis, absence of inspiration, as well as even permanent negative adjustments in cognitive feature. Both THC and also CBD affect the endocannabinoid system in the body. Their action, as currently pointed out, is inconsistent. Cbd-a-thc-in-the-endocannabinoid-1 system When creating images, CBD reduces the deficiency of anandamide resources, and also THC quicken this process. However, this does not indicate that THC is only a harmful cannabinoid and also should not remain in the preparation at all. As a matter of fact. Its small presence in hemp prep work is even required in order to obtain the supposed impact. harmony. THC in full range hemp oil exists in such a limited and also, importantly, legal amount. This amount is so small (less than 0.2) that it does not trigger drunkenness. Collaborating, THC and CBD have greater potential than either particle performing alone. What is anandamide (AEA)? What is its significance for individuals dealing with anxiety? Continue reading! CBD, Depression as well as the endocannabinoid system The endocannabinoid system is a crucial system in charge of the law of basic human physiological processes, such as energy management, neurohormonal as well as neuroimmune links, electric motor task, mood and also motivation, and fat metabolic process. The endocannabinoid system consists of a neurotransmitter called anandamide (AEA). Anandamide is a neurotransmitter that is naturally generated in the human brain. Its production is boosted by e.g. exercise, and also to a minimal extent by the supposed collaborate with the body (massage therapy!). Its resources are "made use of" to preserve the appropriate functioning of the body, consisting of in the field of psychological wellness. As displayed in this research: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high levels of anandamide are related to a lowered risk of creating psychotic signs. A high degree of anandamide is likewise connected with a positive result on the reduction of clinical depression and also stress and anxiety signs. This mechanism is still not completely recognized, but it appears logical that a strongly clinically depressed mood in a private amount of time for a details situation, and with the simultaneous lack of activities focused on its improvement, results in an increase of the influx of adverse thoughts. As depressive conditions develop, they can become a lot more harmful types of conditions, e.g. psychosis, misconceptions or schizophrenia. Slowing down this procedure as swiftly as possible might become crucial in the efficient therapy of mental disorders of human performance.

    https://www.laweekly.com/best-cbd-for-anxiety-which-cbd-product-is-best-for-stress-and-anxiety/

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.