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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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Main definitions recommend that depressive conditions, additionally known informally as depression, are defined by: sudden clinical depression of a person's mood, in the adverse instructions, of moderate to solid strength of the strength of the experienced adjustments, for greater than a couple of weeks. There might be one or more factors for the occurrence of changes. It also takes place that it is difficult to identify any unequivocal factor. We really often found the statement that it is a people disease of the 21st century – it influences both older as well as younger people. Our education is trivial for anxiety, let alone our incomes – it can impact anybody. Treatment of depression boils down to: pharmacotherapy, psychotherapy and psychoeducation, photo-therapy, electroconvulsive therapy and also even more natural tasks related to the climax of physical activity and also the introduction of considerable adjustments in the day-to-day diet plan. It is as part of all-natural methods of battling and neutralizing depression that the addition of marijuana preparations with cannabinoids naturally happening in the plant in the everyday diet is getting more and more popularity in the world. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, appears in many scientific research studies as a possibly efficient cannabinoid in the therapy of depression. Notably, it is a 100 natural chemical compound of plant origin. Interestingly, depression is among the 3 most common mental illness in which individuals turn to CBD hemp preparations such as CBD oil, complete spectrum hemp oil with CBD or CBD capsules. Records from consumers and their favorable opinions on the efficiency of e.g. CBD oil or full spectrum hemp oil with natural CBD are expanding at an extraordinary rate. THC as well as CBD cannabinoids – distinctions The primary cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) as well as CBD (cannabidiol). They show antagonistic impacts, which implies that CBD lowers the impacts of THC. What are these results? THC has an envigorating impact, triggers a feeling of bliss, impacts cognitive features, however also kicks back. Huge, frequently consumed doses of THC are taken into consideration hazardous to the human mind. Extreme usage of THC can cause psychosis, lack of motivation, and also also long-term adverse modifications in cognitive feature. Both THC as well as CBD impact the endocannabinoid system in the body. Their action, as already stated, is inconsistent. Cbd-a-thc-in-the-endocannabinoid-1 system When creating pictures, CBD decreases the depletion of anandamide resources, and also THC accelerate this procedure. 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As depressive problems develop, they can develop into even more hazardous types of disorders, e.g. psychosis, misconceptions or schizophrenia. Slowing down this procedure as quickly as possible might become vital in the effective therapy of mental illness of human functioning.

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Official meanings suggest that depressive conditions, likewise known colloquially as clinical depression, are identified by: abrupt depression of a person's state of mind, in the negative direction, of modest to strong strength of the strength of the skilled modifications, for more than a few weeks. There might be several factors for the incident of changes. It likewise happens that it is tough to recognize any absolute reason. We really frequently stumbled upon the statement that it is a human being illness of the 21st century – it impacts both older as well as more youthful individuals. Our education and learning is not important for clinical depression, let alone our earnings – it can influence anybody. Treatment of anxiety boils down to: pharmacotherapy, psychotherapy as well as psychoeducation, photo-therapy, electroconvulsive therapy and even more all-natural activities related to the rise of physical activity and the introduction of substantial adjustments in the everyday diet. It is as part of natural methods of battling as well as counteracting depression that the inclusion of marijuana preparations with cannabinoids naturally occurring in the plant in the daily diet is acquiring a growing number of popularity worldwide. Cannabidiol CBD, found in e.g. CBD oil or full-spectrum hemp oil, shows up in numerous scientific researches as a potentially efficient cannabinoid in the treatment of depression. Notably, it is a 100 all-natural chemical compound of plant beginning. Remarkably, anxiety is among the three most usual mental illness in which patients turn to CBD hemp prep work such as CBD oil, full range hemp oil with CBD or CBD capsules. Reports from consumers and also their positive point of views on the efficiency of e.g. CBD oil or complete spectrum hemp oil with natural CBD are growing at an unmatched rate. THC and CBD cannabinoids – distinctions The primary cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). 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THC in full spectrum hemp oil is present in such a limited and, significantly, legal amount. This amount is so tiny (less than 0.2) that it does not create intoxication. Interacting, THC and also CBD have better possibility than either molecule performing alone. What is anandamide (AEA)? What is its value for people experiencing clinical depression? Read on! CBD, Depression and also the endocannabinoid system The endocannabinoid system is an essential system in charge of the guideline of standard human physiological procedures, such as energy administration, neurohormonal and also neuroimmune links, motor activity, mood and motivation, and fat metabolism. The endocannabinoid system includes a natural chemical called anandamide (AEA). Anandamide is a natural chemical that is naturally created in the human mind. Its production is stimulated by e.g. physical activity, and also to a lesser level by the so-called collaborate with the body (massage therapy!). Its resources are "made use of" to preserve the proper performance of the body, consisting of in the field of mental wellness. As received this research study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high degrees of anandamide are related to a decreased risk of establishing psychotic symptoms. A high level of anandamide is also associated with a positive impact on the reduction of anxiety and anxiety signs. This system is still not totally comprehended, but it appears rational that a strongly depressed mood in a specific period for a details case, and with the synchronised absence of activities focused on its enhancement, causes an intensification of the increase of negative thoughts. As depressive problems develop, they can develop into even more dangerous types of problems, e.g. psychosis, delusions or schizophrenia. Slowing down this process as promptly as feasible may end up being crucial in the effective treatment of mental illness of human functioning.

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    CBD for Anxiety as well as Anxiety: Visualize that it is feasible to present one natural prep work into your day-to-day diet plan, which can verify to be the secret to winning the fight for a calmer life for individuals with depressive conditions. What if the incorporation of this prep work, developed on the basis of a progressively widely known as well as evaluated chemical substance of plant beginning, is not just possibly very effective, but is not associated with the danger of adverse effects regular of pharmacological drugs? Is it also possible? Where's the catch? Do you would like to know more? Read this write-up In this write-up we will cover: What is depression? THC distinctions Depression as well as the endocannabinoid system What is depression? Main interpretations recommend that depressive conditions, additionally recognized colloquially as depression, are identified by: unexpected anxiety of an individual's mood, in the negative instructions, of modest to solid strength of the intensity of the skilled changes, for more than a couple of weeks. There may be one or more factors for the occurrence of changes. It additionally occurs that it is challenging to determine any unequivocal reason. We very usually come across the declaration that it is a people disease of the 21st century – it influences both older as well as more youthful people. Our education and learning is trivial for clinical depression, let alone our revenues – it can affect any individual. Treatment of anxiety boils down to: pharmacotherapy, psychotherapy and also psychoeducation, phototherapy, electroconvulsive therapy and also even more natural activities related to the increase of exercise and also the intro of considerable modifications in the day-to-day diet regimen. It is as part of all-natural techniques of combating and counteracting anxiety that the addition of marijuana prep work with cannabinoids naturally taking place in the plant in the daily diet plan is getting increasingly more popularity on the planet. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, shows up in various clinical researches as a possibly effective cannabinoid in the therapy of anxiety. Notably, it is a 100 all-natural chemical compound of plant origin. Remarkably, anxiety is amongst the three most usual mental illness in which clients turn to CBD hemp preparations such as CBD oil, complete spectrum hemp oil with CBD or CBD capsules. Records from consumers and also their favorable opinions on the efficiency of e.g. CBD oil or complete range hemp oil with natural CBD are expanding at an unprecedented rate. THC and CBD cannabinoids – differences The main cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and also CBD (cannabidiol). They show antagonistic results, which indicates that CBD minimizes the impacts of THC. What are these impacts? THC has an intoxicating effect, causes a feeling of ecstasy, impacts cognitive functions, yet likewise loosens up. Large, on a regular basis taken in dosages of THC are taken into consideration dangerous to the human brain. Too much consumption of THC can result in psychosis, absence of motivation, as well as even irreversible adverse modifications in cognitive function. Both THC as well as CBD influence the endocannabinoid system in the body. Their activity, as currently discussed, is inconsistent. Cbd-a-thc-in-the-endocannabinoid-1 system When writing pictures, CBD reduces the deficiency of anandamide resources, and THC accelerate this procedure. However, this does not mean that THC is just a damaging cannabinoid as well as must not be in the preparation in all. However. Its little presence in hemp preparations is even required in order to get the supposed result. harmony. THC in full spectrum hemp oil exists in such a limited and also, notably, legal amount. This amount is so small (less than 0.2) that it does not trigger intoxication. Interacting, THC and also CBD have greater potential than either molecule performing alone. What is anandamide (AEA)? What is its relevance for individuals suffering from depression? Keep reading! CBD, Depression and the endocannabinoid system The endocannabinoid system is a crucial system responsible for the guideline of basic human physiological procedures, such as power management, neurohormonal as well as neuroimmune links, electric motor task, state of mind as well as motivation, and fat metabolism. The endocannabinoid system includes a neurotransmitter called anandamide (AEA). Anandamide is a neurotransmitter that is naturally created in the human brain. Its production is stimulated by e.g. exercise, and also to a minimal level by the so-called work with the body (massage!). Its sources are "used" to preserve the proper functioning of the body, consisting of in the field of mental health. As shown in this study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high degrees of anandamide are related to a lowered risk of establishing psychotic signs. A high degree of anandamide is likewise related to a favorable result on the decrease of depression and anxiety signs. This device is still not totally comprehended, however it appears logical that a highly depressed mood in a private period for a specific situation, and also with the simultaneous absence of actions focused on its improvement, causes an intensification of the influx of negative thoughts. As depressive conditions develop, they can become much more unsafe kinds of problems, e.g. psychosis, misconceptions or schizophrenia. Slowing down this process as quickly as possible may end up being critical in the effective therapy of mental illness of human functioning.

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    CBD for Stress And Anxiety as well as Depression: Think of that it is feasible to present one natural preparation into your daily diet, which might verify to be the key to winning the fight for a calmer life for individuals with depressive disorders. Suppose the inclusion of this prep work, developed on the basis of a progressively well-known as well as checked chemical compound of plant beginning, is not only potentially very effective, however is not related to the risk of adverse effects regular of pharmacological drugs? Is it also feasible? Where's the catch? Do you want to know even more? Read this post In this article we will certainly cover: What is anxiety? THC distinctions Clinical depression as well as the endocannabinoid system What is anxiety? Main definitions suggest that depressive problems, likewise understood colloquially as depression, are characterized by: unexpected anxiety of an individual's state of mind, in the unfavorable instructions, of modest to strong strength of the intensity of the skilled adjustments, for more than a couple of weeks. There may be one or more reasons for the incident of adjustments. It likewise occurs that it is challenging to identify any kind of absolute reason. We extremely frequently stumbled upon the declaration that it is a people condition of the 21st century – it affects both older and also younger people. Our education and learning is not important for depression, not to mention our incomes – it can affect any person. Treatment of depression comes down to: pharmacotherapy, psychotherapy and psychoeducation, phototherapy, electroconvulsive therapy and more all-natural tasks connected to the rise of physical activity and also the introduction of considerable modifications in the everyday diet. It is as part of natural approaches of fighting as well as counteracting depression that the inclusion of cannabis preparations with cannabinoids naturally occurring in the plant in the day-to-day diet plan is getting increasingly more appeal worldwide. Cannabidiol CBD, found in e.g. CBD oil or full-spectrum hemp oil, shows up in countless clinical researches as a potentially effective cannabinoid in the therapy of anxiety. Notably, it is a 100 all-natural chemical substance of plant beginning. Surprisingly, anxiety is among the three most usual mental illness in which clients resort to CBD hemp preparations such as CBD oil, complete range hemp oil with CBD or CBD pills. Reports from consumers as well as their favorable viewpoints on the performance of e.g. CBD oil or complete spectrum hemp oil with all-natural CBD are expanding at an unmatched rate. THC as well as CBD cannabinoids – distinctions The main cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) as well as CBD (cannabidiol). They reveal antagonistic effects, which means that CBD decreases the effects of THC. What are these results? THC has an intoxicating result, creates a sensation of ecstasy, influences cognitive functions, but also kicks back. Big, routinely eaten doses of THC are considered unsafe to the human brain. Too much usage of THC can result in psychosis, absence of motivation, as well as also permanent adverse modifications in cognitive function. Both THC as well as CBD impact the endocannabinoid system in the human body. Their activity, as already discussed, is inconsistent. Cbd-a-thc-in-the-endocannabinoid-1 system When writing images, CBD slows down the depletion of anandamide resources, as well as THC quicken this process. However, this does not mean that THC is only a hazardous cannabinoid and also should not remain in the preparation in any way. As a matter of fact. Its tiny presence in hemp preparations is also required in order to acquire the so-called impact. harmony. THC completely spectrum hemp oil exists in such a limited and, importantly, legal amount. This amount is so little (less than 0.2) that it does not trigger intoxication. Working together, THC as well as CBD have better capacity than either particle acting alone. What is anandamide (AEA)? What is its importance for individuals dealing with anxiety? Continue reading! CBD, Clinical depression and also the endocannabinoid system The endocannabinoid system is an essential system responsible for the policy of fundamental human physical processes, such as power monitoring, neurohormonal and also neuroimmune links, motor activity, mood and also motivation, and fat metabolic rate. The endocannabinoid system includes a neurotransmitter called anandamide (AEA). Anandamide is a neurotransmitter that is naturally generated in the human brain. Its manufacturing is promoted by e.g. physical activity, and to a lower extent by the so-called work with the body (massage!). Its resources are "utilized" to preserve the proper performance of the body, consisting of in the field of mental health. As received this study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high levels of anandamide are connected with a lowered threat of establishing psychotic signs. A high level of anandamide is also associated with a positive effect on the reduction of anxiety as well as anxiety symptoms. This device is still not totally recognized, however it seems sensible that a strongly clinically depressed state of mind in a private amount of time for a specific case, as well as with the simultaneous lack of activities focused on its renovation, results in an increase of the influx of unfavorable thoughts. As depressive disorders establish, they can develop into much more harmful types of disorders, e.g. psychosis, deceptions or schizophrenia. Decreasing this procedure as swiftly as possible might end up being crucial in the reliable therapy of mental illness of human functioning.

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    CBD for Stress And Anxiety and also Depression: Picture that it is possible to introduce one natural prep work right into your everyday diet, which could confirm to be the key to winning the defend a calmer life for individuals with depressive problems. What happens if the incorporation of this preparation, created on the basis of a progressively well-known and examined chemical substance of plant origin, is not just possibly extremely effective, but is not associated with the risk of adverse effects typical of medicinal medicines? Is it also possible? Where's the catch? Do you need to know more? Read this post In this short article we will certainly cover: What is clinical depression? THC distinctions Depression as well as the endocannabinoid system What is anxiety? Main meanings suggest that depressive problems, likewise recognized colloquially as depression, are defined by: abrupt anxiety of an individual's mood, in the negative direction, of modest to strong strength of the intensity of the skilled changes, for greater than a few weeks. There might be one or more reasons for the event of changes. It also occurs that it is challenging to identify any kind of absolute factor. We extremely frequently stumbled upon the declaration that it is a human being disease of the 21st century – it influences both older and younger individuals. Our education is not important for depression, not to mention our profits – it can affect anyone. Therapy of anxiety boils down to: pharmacotherapy, psychotherapy and psychoeducation, photo-therapy, electroconvulsive therapy as well as even more all-natural activities related to the augmentation of physical activity and the intro of significant adjustments in the day-to-day diet plan. It is as part of all-natural techniques of combating and combating clinical depression that the incorporation of marijuana preparations with cannabinoids normally happening in the plant in the day-to-day diet regimen is getting increasingly more popularity in the world. Cannabidiol CBD, discovered in e.g. CBD oil or full-spectrum hemp oil, shows up in numerous clinical studies as a possibly efficient cannabinoid in the treatment of clinical depression. Importantly, it is a 100 natural chemical substance of plant beginning. Interestingly, clinical depression is amongst the 3 most typical mental disorders in which people resort to CBD hemp prep work such as CBD oil, full spectrum hemp oil with CBD or CBD pills. Records from consumers and their favorable opinions on the effectiveness of e.g. CBD oil or complete range hemp oil with all-natural CBD are growing at an unmatched speed. THC and CBD cannabinoids – distinctions The primary cannabinoids in the marijuana plant are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). They reveal antagonistic effects, which implies that CBD minimizes the impacts of THC. What are these effects? THC has an envigorating result, causes a feeling of ecstasy, impacts cognitive features, yet additionally unwinds. Big, routinely consumed doses of THC are thought about dangerous to the human brain. Extreme usage of THC can bring about psychosis, absence of inspiration, as well as also long-term unfavorable changes in cognitive function. Both THC as well as CBD affect the endocannabinoid system in the body. Their activity, as already mentioned, is contradictory. Cbd-a-thc-in-the-endocannabinoid-1 system When writing images, CBD slows down the depletion of anandamide resources, as well as THC quicken this procedure. However, this does not imply that THC is only an unsafe cannabinoid and also ought to not remain in the prep work in all. On the other hand. Its tiny presence in hemp prep work is even necessary in order to acquire the supposed result. synergy. THC completely range hemp oil exists in such a limited and also, notably, legal amount. This amount is so small (less than 0.2) that it does not cause drunkenness. Working together, THC and CBD have better capacity than either particle acting alone. What is anandamide (AEA)? What is its significance for people experiencing clinical depression? Continue reading! CBD, Depression as well as the endocannabinoid system The endocannabinoid system is a vital system responsible for the law of standard human physiological processes, such as power administration, neurohormonal and also neuroimmune connections, motor task, mood and also inspiration, and fat metabolism. The endocannabinoid system consists of a natural chemical called anandamide (AEA). Anandamide is a natural chemical that is normally generated in the human brain. Its manufacturing is boosted by e.g. physical activity, as well as to a lower extent by the supposed collaborate with the body (massage therapy!). Its resources are "used" to keep the correct performance of the body, consisting of in the field of psychological health. As received this study: https://www.ncbi.nlm.nih.gov/pubmed/23580381 high levels of anandamide are related to a decreased danger of establishing psychotic symptoms. A high level of anandamide is likewise related to a positive effect on the decrease of clinical depression and also anxiousness signs and symptoms. This mechanism is still not fully recognized, but it appears sensible that a strongly clinically depressed state of mind in a private time period for a specific situation, as well as with the simultaneous absence of actions focused on its improvement, brings about an augmentation of the increase of negative ideas. As depressive conditions develop, they can develop into much more dangerous types of disorders, e.g. psychosis, deceptions or schizophrenia. Reducing this procedure as rapidly as feasible might end up being vital in the efficient treatment of mental illness of human performance.

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Official interpretations recommend that depressive disorders, also recognized colloquially as anxiety, are identified by: unexpected depression of an individual's mood, in the unfavorable instructions, of modest to solid strength of the strength of the knowledgeable modifications, for more than a couple of weeks. There may be one or more reasons for the event of adjustments. It likewise happens that it is challenging to determine any kind of unequivocal reason. We extremely usually encountered the statement that it is a human being illness of the 21st century – it influences both older and younger individuals. Our education is trivial for anxiety, not to mention our earnings – it can influence any individual. Therapy of anxiety comes down to: pharmacotherapy, psychotherapy as well as psychoeducation, photo-therapy, electroconvulsive therapy as well as even more all-natural tasks associated with the aggravation of physical activity as well as the intro of substantial adjustments in the daily diet. It is as part of all-natural methods of combating as well as combating depression that the inclusion of marijuana preparations with cannabinoids normally occurring in the plant in the day-to-day diet is gaining an increasing number of appeal on the planet. Cannabidiol CBD, located in e.g. CBD oil or full-spectrum hemp oil, shows up in many clinical research studies as a potentially reliable cannabinoid in the therapy of depression. Notably, it is a 100 all-natural chemical compound of plant beginning. Remarkably, anxiety is among the three most common mental disorders in which patients resort to CBD hemp prep work such as CBD oil, full range hemp oil with CBD or CBD pills. 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