Predictors of referral for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer and changes in practice over time

Authors

  • Geoffrey T. Gotto University of Calgary
  • Melissa Shea-Budgell University of Calgary Alberta Health Services
  • M. Sarah Rose Alberta Health Services
  • J. Dean Ruether University of Calgary Alberta Health Services

DOI:

https://doi.org/10.5489/cuaj.2722

Keywords:

urothelial carcinoma, neoadjuvant chemotherapy, radical cystectomy

Abstract

Introduction: In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival.

Methods: Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate.

Results: Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6–50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030).

Conclusions: NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.

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Author Biographies

Geoffrey T. Gotto, University of Calgary

Assistant ProfessorDepartment of SurgeryCumming School of MedicineUniversity of Calgary

Melissa Shea-Budgell, University of Calgary Alberta Health Services

Adjunct LecturerDepartment of OncologyCumming School of MedicineUniversity of Calgary

M. Sarah Rose, Alberta Health Services

n/a

J. Dean Ruether, University of Calgary Alberta Health Services

Associate ProfessorDepartment of OncologyCumming School of MedicineUniversity of Calgary

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Published

2015-08-10

How to Cite

Gotto, G. T., Shea-Budgell, M., Rose, M. S., & Ruether, J. D. (2015). Predictors of referral for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer and changes in practice over time. Canadian Urological Association Journal, 9(7-8), 236–41. https://doi.org/10.5489/cuaj.2722

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Section

Case Series