An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec
Background: The province of Quebec has the highest incidence of urothelial
tumours in Canada. Radical cystectomy remains the standard treatment for invasive
bladder cancer. We have previously observed that prolonged delays between
transurethral resection of bladder tumour (TURBT) and radical cystectomy lead
to worse survival in Quebec.
Objective: The aim of our study was to characterize the various periods of delay
sustained by bladder cancer patients before radical cystectomy across Quebec
and to determine their relation to survival.
Methods: We obtained the billing records for all patients treated with radical
cystectomies for bladder cancer across Quebec from 1990 to 2002. Collected
information included patient age and sex; dates of family physician (FP) and
specialist visits with accompanying diagnoses; dates of cystoscopy, TURBT and
CT scanning; surgeon age; surgical volume and dates of death.
Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnostic
delays from FP to specialist, then to cystoscopy, then to TURBT and finally
from TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entire
study period. Median overall delay from FP visit to radical cystectomy was
93 days. In addition, median FP to radical cystectomy delay progressively
increased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analyses
showed that patients with an overall delay of either < 25 or > 84 days
had a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).
Conclusion: Preoperative delays have been progressively increasing over time.
Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translate
into worse outcomes. Poor survival in cases with < 25 days delay may
be attributed to case selection, with more advanced cases being managed much
quicker. Poor survival in cases with delays of > 84 days may be attributed to
disease progression while awaiting completion of management.
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