Christopher M Booth1, David Robert Siemens2, Yingwei Peng3, William J Mackillop4. 1. Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen׳s University, Kingston, Canada. Electronic address: boothc@kgh.kari.net. 2. Department of Oncology, Queen׳s University, Kingston, Canada; Department of Urology, Queen׳s University, Kingston, Canada. 3. Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen׳s University, Kingston, Canada. 4. Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen׳s University, Kingston, Canada; Department of Public Health Sciences, Queen׳s University, Kingston, Canada.
Abstract
PURPOSE: Reasons for low uptake of perioperative chemotherapy for muscle-invasive bladder cancer are not well described. Herein, we report referral patterns from urology to medical oncology (MO) in Ontario, Canada, and subsequent use of chemotherapy. METHODS: Electronic treatment records were linked to the Ontario Cancer Registry to describe referral patterns and use of neoadjuvant/adjuvant chemotherapy (NACT/ACT) among patients with muscle-invasive bladder cancer treated with cystectomy in Ontario from 1994 to 2008. Logistic regression identified factors associated with referral to MO and use of NACT/ACT. RESULTS: Overall, 18% (520/2,944) of patients were seen by MO before cystectomy, and 25% (128/520) of referred cases were treated with NACT. Among patients not treated with NACT or radiation, 39% (1,085/2,809) were seen by MO following cystectomy; 51% (548/1,085) of referred patients had ACT. There was wide geographic variation in MO referral rates before (range: 5%-40%) and after cystectomy (range: 26%-59%). Patients seen by MO from 2004 to 2008 were more likely to receive ACT (57%) compared with patients in earlier years (41% in 1994-1998 and 46% in 1999-2003, P<0.001). CONCLUSIONS: Lack of referral to MO is an important barrier to use of NACT/ACT. Upstream decision making by urologists is an important target in future knowledge translation.
PURPOSE: Reasons for low uptake of perioperative chemotherapy for muscle-invasive bladder cancer are not well described. Herein, we report referral patterns from urology to medical oncology (MO) in Ontario, Canada, and subsequent use of chemotherapy. METHODS: Electronic treatment records were linked to the Ontario Cancer Registry to describe referral patterns and use of neoadjuvant/adjuvant chemotherapy (NACT/ACT) among patients with muscle-invasive bladder cancer treated with cystectomy in Ontario from 1994 to 2008. Logistic regression identified factors associated with referral to MO and use of NACT/ACT. RESULTS: Overall, 18% (520/2,944) of patients were seen by MO before cystectomy, and 25% (128/520) of referred cases were treated with NACT. Among patients not treated with NACT or radiation, 39% (1,085/2,809) were seen by MO following cystectomy; 51% (548/1,085) of referred patients had ACT. There was wide geographic variation in MO referral rates before (range: 5%-40%) and after cystectomy (range: 26%-59%). Patients seen by MO from 2004 to 2008 were more likely to receive ACT (57%) compared with patients in earlier years (41% in 1994-1998 and 46% in 1999-2003, P<0.001). CONCLUSIONS: Lack of referral to MO is an important barrier to use of NACT/ACT. Upstream decision making by urologists is an important target in future knowledge translation.
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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
Authors: Melanie Walker; R Christopher Doiron; Simon D French; Deb Feldman-Stewart; D Robert Siemens; William J Mackillop; Christopher M Booth Journal: Can Urol Assoc J Date: 2017-12-22 Impact factor: 1.862