Referral and treatment rates of neoadjuvant chemotherapy in muscle-invasive bladder cancer before and after publication of a clinical practice guideline
DOI:
https://doi.org/10.5489/cuaj.878Abstract
Introduction: The objective of this study was to compare referral
and treatment rates of neoadjuvant chemotherapy for patients with
muscle-invasive bladder cancer before and after publication of a
clinical practice guideline.
Methods: This was a retrospective comparative cohort study of
236 patients diagnosed with clinical stage ≥ T2 bladder cancer
in Alberta, Canada. Patients were divided into 2 groups based
on the time of diagnosis relative to the publication of the Alberta
Genitourinary Oncology Group Clinical Practice Guideline on
Bladder Cancer (CPG), which recommends cisplatin-based neoadjuvant
chemotherapy for muscle-invasive disease. The pre-CPG
group included patients (n = 129) diagnosed prior to publication
of the CPG (November 1, 2002 to October 31, 2004, inclusively).
The post-CPG group included patients (n = 107) diagnosed after
publication of the CPG (November 1, 2005 to October 31, 2007).
There was an accrual blackout period of 6 months before and after
the CPG release date. The primary analysis compared the two
groups with respect to neoadjuvant chemotherapy referral rates,
treatment-offered rates and treatment-administered rates.
Results: Referral to medical oncology regarding neoadjuvant
chemotherapy occurred in 2.3% and 23.4% of patients in the
pre- and post-CPG groups, respectively (p < 0.01). Neoadjuvant
chemotherapy was offered to 0.8% and 18.7% of patients in the
pre- and post-CPG groups, respectively (p < 0.01). Neoadjuvant
chemotherapy was administered to 0.8% and 14.0% of patients in
the pre- and post-CPG groups, respectively (p < 0.01).
Interpretation: Neoadjuvant referral and treatment rates increased
after publication of the CPG. However, overall referral and treatment
rates remained low, which warrants additional exploration.
Introduction : L’objectif de l’étude était de comparer les taux de
recommandation et de traitement par chimiothérapie néoadjuvante
chez les patients atteints de cancer de la vessie avec envahissement
musculaire avant et après la publication d’un guide de pratique
clinique.
Méthodologie : Il s’agit ici d’une étude comparative rétrospective
de cohorte comptant 236 patients de l’Alberta, au Canada, chez
qui on avait diagnostiqué un cancer de la vessie de stade clinique
T2 ou pire. Les patients ont été répartis en 2 groupes selon que leur
diagnostic avait été posé avant ou après la publication du guide
de pratique clinique sur le cancer de la vessie (GPC) de l’Alberta
Genitourinary Oncology Group, qui recommande une chimiothérapie
néoadjuvante à base de cisplatine pour le traitement des
cas de cancer avec envahissement musculaire. Le groupe pré-GPC
comprenait des patients (n = 129) chez qui le diagnostic avait
été posé avant la publication du GPC (du 1er novembre 2002 au
31 octobre 2004, inclusivement). Le groupe post-GPC incluait des
patients (n = 107) chez qui le diagnostic avait été posé après la
publication du GPC (du 1er novembre 2005 au 31 octobre 2007).
Une période cumulative de censure a été calculée 6 mois avant et
après la date de publication du GPC. L’analyse préliminaire a comparé
les deux groupes quant aux taux de recommandation de la
chimiothérapie néoadjuvante, aux taux d’offre et d’administration
du traitement.
Résultats : La chimiothérapie néoadjuvante a été recommandée chez
2,3 et 23,4 % des patients dans les groupes pré-GPC et post-GPC,
respectivement (p < 0,01). Elle a été offerte à 0,8 % et 18,7 % des
patients de ces mêmes groupes (p < 0,01), et administrée à 0,8 et
14,0 % des patients des groupes pré-GPC et post-GPC, respectivement
(p < 0,01).
Interprétation : Les taux de recommandation et de traitement concernant
la chimiothérapie néoadjuvante ont augmenté après la
publication du GPC, mais sont tout de même demeurés faibles,
ce qui nécessite une analyse plus poussée.
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