An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec

Authors

  • Nader Fahmy Department of Surgery (Urology), McGill University, Montréal, QC
  • Wassim Kassouf Department of Surgery (Urology), McGill University, Montréal, QC
  • Suganthiny Jeyaganth Department of Surgery (Urology), McGill University, Montréal, QC
  • Moamen Amin Department of Surgery (Urology), McGill University, Montréal, QC
  • Salaheddin Mahmud Department of Community Heath Sciences, University of Manitoba, Winnipeg, Man
  • Jordan Steinberg Department of Surgery (Urology), McGill University, Montréal, QC
  • Simon Tanguay Department of Surgery (Urology), McGill University, Montréal, QC
  • Armen Aprikian Department of Surgery (Urology), McGill University, Montréal, QC

DOI:

https://doi.org/10.5489/cuaj.482

Abstract

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.

Downloads

Download data is not yet available.

Author Biographies

Nader Fahmy, Department of Surgery (Urology), McGill University, Montréal, QC

Wassim Kassouf, Department of Surgery (Urology), McGill University, Montréal, QC

Suganthiny Jeyaganth, Department of Surgery (Urology), McGill University, Montréal, QC

Moamen Amin, Department of Surgery (Urology), McGill University, Montréal, QC

Salaheddin Mahmud, Department of Community Heath Sciences, University of Manitoba, Winnipeg, Man

Jordan Steinberg, Department of Surgery (Urology), McGill University, Montréal, QC

Simon Tanguay, Department of Surgery (Urology), McGill University, Montréal, QC

Armen Aprikian, Department of Surgery (Urology), McGill University, Montréal, QC

Downloads

How to Cite

Fahmy, N., Kassouf, W., Jeyaganth, S., Amin, M., Mahmud, S., Steinberg, J., Tanguay, S., & Aprikian, A. (2013). An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec. Canadian Urological Association Journal, 2(2), 102–8. https://doi.org/10.5489/cuaj.482

Issue

Vol. 2 No. 2 (2008): CUAJ April

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.