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.
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 cancerpatients 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.
Authors: Ricardo F Sánchez-Ortiz; William C Huang; Rosemarie Mick; Keith N Van Arsdalen; Alan J Wein; S Bruce Malkowicz Journal: J Urol Date: 2003-01 Impact factor: 7.450
Authors: Cheryl T Lee; Rabii Madii; Stephanie Daignault; Rodney L Dunn; Yingxi Zhang; James E Montie; David P Wood Journal: J Urol Date: 2006-04 Impact factor: 7.450
Authors: Wassim Kassouf; Armen Aprikian; Fred Saad; Rodney H Breau; Girish Kulkarni; David M Guttman; Ken Bagshaw; Jonathan Izawa; Libni Eapen; Adrian Fairey; Alan So; Scott North; Ricardo Rendon; Srikala S Sridhar; Fadi Brimo; Peter Chung; Darrel Drachenberg; Yves Fradet; Niels Jacobsen; Chris Morash; Bobby Shayegan; Geoffrey Gotto; Alex Zlotta; Neil Fleshner; D Robert Siemens; Peter C Black Journal: Can Urol Assoc J Date: 2018-03-19 Impact factor: 1.862
Authors: Tracy L Rose; Allison M Deal; Ethan Basch; Paul A Godley; W Kimryn Rathmell; William Y Kim; Young E Whang; Mary W Dunn; Andrew Wang; Ronald C Chen; Matthew E Nielsen; Raj S Pruthi; Eric M Wallen; Michael E Woods; Angela B Smith; Matthew I Milowsky Journal: Urol Oncol Date: 2015-06-27 Impact factor: 3.498
Authors: Wassim Kassouf; Armen Aprikian; Peter Black; Girish Kulkarni; Jonathan Izawa; Libni Eapen; Adrian Fairey; Alan So; Scott North; Ricardo Rendon; Srikala S Sridhar; Tarik Alam; Fadi Brimo; Normand Blais; Chris Booth; Joseph Chin; Peter Chung; Darrel Drachenberg; Yves Fradet; Michael Jewett; Ron Moore; Chris Morash; Bobby Shayegan; Geoffrey Gotto; Neil Fleshner; Fred Saad; D Robert Siemens Journal: Can Urol Assoc J Date: 2016-02-08 Impact factor: 1.862