Regional differences in practice patterns and outcomes in patients treated with radical cystectomy in a universal health care system

Authors

  • Bassel G. Bachir Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada
  • Armen G. Aprikian Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada
  • Yves Fradet Department of Surgery (Urology), Laval University, Quebec, Quebec, Canada
  • Joseph L. Chin Department of Surgery (Urology), University of Western Ontario, London, Ontario, Canada
  • Jonathan Izawa Department of Surgery (Urology), University of Western Ontario, London, Ontario, Canada
  • Ricardo Rendon Department Urology, Dalhousie University, Halifax, Nova Scotia, Canada
  • Eric Estey Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada
  • Adrian Fairey Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada
  • Ilias Cagiannos Department of Surgery (Urology), University of Ottawa, Ottawa, Ontario, Canada
  • Louis Lacombe Department of Surgery (Urology), Laval University, Quebec, Quebec, Canada
  • Jean-Baptiste Lattouf Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada
  • David Bell Department Urology, Dalhousie University, Halifax, Nova Scotia, Canada
  • Fred Saad Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada
  • Darrel Drachenberg Department of Surgery (Urology), Winnipeg, Manitoba, Canada
  • Wassim Kassouf Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada

DOI:

https://doi.org/10.5489/cuaj.201

Keywords:

bladder cancer, practice patterns, radical cystectomy, neoadjuvant chemotherapy, outcome

Abstract

Introduction: Our objective is to assess differences in practice patterns and outcomes across 3 regions in bladder cancer patients treated with radical cystectomy under a universal healthcare system.

Methods: In total, we included 2287 patients treated with radical cystectomy at 8 Canadian centres from 1998 to 2008. Variables included various clinico-pathologic parameters, recurrence, and death stratified into different regions.

Results: In total, 1105 patients were from the east region (group1), 601 from the centre region (group 2), and 581 from the west region of Canada (group 3). The median follow-up of groups 1, 2, and 3 was 22.1, 17.1, and 28.6 months, respectively. Although the overall rate of neoadjuvant chemotherapy was low (3.1%), rates were higher in group 2 compared with groups 1 and 3 (p = 0.07). Continent diversions and extended lymphadenectomy were performed in 23.5%, 8.5%, 23.9% and 39.7%, 27.7%, 12.6% across groups 1, 2, and 3, respectively. There were statistically significant differences in gender distribution, performance of lymphadenectomy, presence of concomitant carcinoma in situ and lymphovascular invasion across the 3 groups. There were no differences among the 3 geographical locations in terms of stage, surgical margin status, and use of adjuvant chemotherapy. The mean number of days from the transurethral resection of the bladder tumour to cystectomy was 50, 79, 69 days for groups 1, 2, 3, respectively (p = 0.0006). The 5-year overall survival was 53.6%, 66.8%, and 52.4% for groups 1, 2 and 3, respectively (p < 0.0001).

Conclusions: Significant variations in practice patterns were noted across different geographic regions in a universal healthcare system. Use of continent diversions, extended lymphadenectomy, and neoadjuvant chemotherapy remains low across all 3 regions. Treatment delays are significant.

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Published

2013-11-08

How to Cite

Bachir, B. G., Aprikian, A. G., Fradet, Y., Chin, J. L., Izawa, J., Rendon, R., Estey, E., Fairey, A., Cagiannos, I., Lacombe, L., Lattouf, J.-B., Bell, D., Saad, F., Drachenberg, D., & Kassouf, W. (2013). Regional differences in practice patterns and outcomes in patients treated with radical cystectomy in a universal health care system. Canadian Urological Association Journal, 7(11-12), e667–72. https://doi.org/10.5489/cuaj.201

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Section

Original Research