The initiation of a multidisciplinary bladder cancer clinic and the uptake of neoadjuvant chemotherapy: A time-series analysis

  • Madhur Nayan
  • Bimal Bhindi
  • Julie L. Yu
  • Muhammad Mamdani
  • Neil E. Fleshner
  • Thomas Hermanns
  • Peter Chung
  • Michael Milosevic
  • Robert Bristow
  • Padraig Warde
  • Robert J. Hamilton
  • Antonio Finelli
  • Michael A.S. Jewett
  • Alexandre R. Zlotta
  • Srikala S. Sridhar
  • Girish S. Kulkarni

Abstract

Introdcution: While level 1 evidence supports the use of neo-adjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer (MIBC), its uptake has been underwhelming even in academic centres. Our aim was to determine if the initiation of a multidisciplinary bladder cancer clinic (MDBCC) in 2008 at our institution, where patients are assessed simultaneously by bladder cancer-focused urologists and radiation oncologists with easy access to a medical oncologist, was associated with an increased use of NAC.

Methods: Patients with MIBC initiating treatment between July 2000 and June 2013 were identified and classified by academic year (July 1 to June 30). Time-series analyses using interventional autoregressive integrated moving average (ARIMA) models with ramp intervention functions were then conducted. A sensitivity analysis was performed on clinical N0 patients.

Results: The cohort included 278 patients: 168 from 2000-2007 and 110 from 2008-2012 (academic years). Forty-two (15.1%) patients received NAC and 74 (26.6%) received adjuvant chemotherapy (AC). Overall the proportion of patients receiving NAC increased from 7.7% before the MDBCC to 47.6% in 2012 (Interventional ARIMA p=0.036). The results were similar when restricting to cN0 patients (p<0.001). NAC use gradually increased over time regardless of MDBCC attendance, although the proportion of patients receiving NAC appears to have risen more sharply among MDBCC attendees.

Conclusions: At our institution, the initiation of the MDBCC was temporally associated with increased use of NAC. In addition to multidisciplinary collaboration, having a critical mass of NAC physician advocates and support from institutional leaders are essential to the uptake of NAC.
Published
2016-02-16
How to Cite
Nayan, M., Bhindi, B., Yu, J. L., Mamdani, M., Fleshner, N. E., Hermanns, T., Chung, P., Milosevic, M., Bristow, R., Warde, P., Hamilton, R. J., Finelli, A., Jewett, M. A., Zlotta, A. R., Sridhar, S. S., & Kulkarni, G. S. (2016). The initiation of a multidisciplinary bladder cancer clinic and the uptake of neoadjuvant chemotherapy: A time-series analysis. Canadian Urological Association Journal, 10(1-2), 25-30. https://doi.org/10.5489/cuaj.3315
Section
Original Research