Improving bladder cancer treatment internationally


veeru kasivisvanathan

With the help of TUF funding, Veeru Kasivisvanathan is running the RESECT study to help improve the delivery of bladder cancer surgery.

The main form of surgery for non-muscle invasive bladder cancer is transurethral bladder resection, or TURBT, where the surgeon uses a heated loop to scrape away the cancer.

“We know that if you follow evidence-based guidelines, then you get good results,” says Dr Veeru Kasivisvanathan, a urologist and academic clinical lecturer at University College London.

With the help of funding from TUF, Veeru is running a study called RESECT that will help to improve the delivery of bladder cancer surgery.

“We want to identify whether people are meeting certain criteria for performing TURBT and post-operative care. That will allow us to give feedback to surgeons around the world on how they are doing. Hopefully, they will be able to understand how they can improve their performance and adherence to the guidelines,” he says.

“One of the quality indicators of the surgery is whether or not you obtain muscle in the resection. That’s really important to understand how far the cancer has spread and what treatment is needed. If you don’t have muscle it means the operation may need to be redone.”

A couple of previous small-scale studies have shown that some guidelines are not always followed, including the use of chemotherapy straight after surgery.

“We know from previous studies that giving intravesical chemotherapy will reduce recurrence rates significantly. We’re talking about 10- 20% in 5 years” says Veeru.

The RESECT study also hopes to find out how many surgeons are offering this chemotherapy and why some of them might not be.

“They might not have availability of the product, they may not understand that they’re supposed to give it, or it might be that they have different evidence on which they’re basing their management. We’ll be able to understand those reasons so that we can address the issue,” he says.

The study is aiming to recruit around 2000 people having TURBT from the UK and around the world.

“We can look for new associations between how the procedure is performed and what will give you a better outcome afterwards. The scale of this study really allows us to investigate some meaningful questions.

“The funding from TUF helps us to cover costs of some of the core aspects of the study, for example statistical help, methodological help and the data management.”

RESECT was born out of a previous study, also supported by TUF, called IDENTIFY, which looked at the diagnosis of bladder cancer.

“That helped us to establish the network, which allowed us to look at this further,” says Veeru.

“There are very few registries that show people how good their TURBT is. We want to provide that opportunity to improve care in this area.”