Geoffrey T Gotto1, Melissa A Shea-Budgell2, M Sarah Rose3, J Dean Ruether2. 1. Department of Surgery, Cumming School of Medicine, University of Calgary, Southern Alberta Institute of Urology, Calgary, AB; 2. Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB; ; Alberta Health Services, Calgary, AB. 3. Alberta Health Services, Calgary, AB.
Abstract
INTRODUCTION: In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival. METHODS: Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate. RESULTS: Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6-50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030). CONCLUSIONS: NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.
INTRODUCTION: In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival. METHODS:Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate. RESULTS: Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6-50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030). CONCLUSIONS:NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.
Authors: D L Lamm; B A Blumenstein; J D Crissman; J E Montie; J E Gottesman; B A Lowe; M F Sarosdy; R D Bohl; H B Grossman; T M Beck; J T Leimert; E D Crawford Journal: J Urol Date: 2000-04 Impact factor: 7.450
Authors: Girish S Kulkarni; David R Urbach; Peter C Austin; Neil E Fleshner; Andreas Laupacis Journal: Can Urol Assoc J Date: 2013 Nov-Dec Impact factor: 1.862
Authors: Jo-An Seah; Normand Blais; Scott North; Yasmin Rahim; Dean Ruether; Peter C Black; Alexandre R Zlotta; Lori Wood; Srikala S Sridhar Journal: Can Urol Assoc J Date: 2013 Sep-Oct Impact factor: 1.862
Authors: Atreya Dash; Joseph A Pettus; Harry W Herr; Bernard H Bochner; Guido Dalbagni; S Machele Donat; Paul Russo; Mary G Boyle; Matthew I Milowsky; Dean F Bajorin Journal: Cancer Date: 2008-11-01 Impact factor: 6.860
Authors: Phillip J Gray; Stacey A Fedewa; William U Shipley; Jason A Efstathiou; Chun Chieh Lin; Anthony L Zietman; Katherine S Virgo Journal: Eur Urol Date: 2012-11-19 Impact factor: 20.096
Authors: Derya Tilki; Oliver Reich; Pierre I Karakiewicz; Giacomo Novara; Wassim Kassouf; Süleyman Ergün; Yves Fradet; Vincenzo Ficarra; Guru Sonpavde; Christian G Stief; Eila Skinner; Robert S Svatek; Yair Lotan; Arthur I Sagalowsky; Shahrokh F Shariat Journal: Eur Urol Date: 2010-01-20 Impact factor: 20.096
Authors: J Alfred Witjes; Eva Compérat; Nigel C Cowan; Maria De Santis; Georgios Gakis; Thierry Lebret; Maria J Ribal; Antoine G Van der Heijden; Amir Sherif Journal: Eur Urol Date: 2013-12-12 Impact factor: 20.096
Authors: Jonas Schiffmann; Maxine Sun; Giorgio Gandaglia; Zhe Tian; Ioana Popa; Alessandro Larcher; Malek Meskawi; Alberto Briganti; Michael McCormack; Shahrokh F Shariat; Francesco Montorsi; Markus Graefen; Fred Saad; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2016 Mar-Apr Impact factor: 1.862
Authors: Tarik Benidir; Jaime Herrera-Caceres; Christopher Wallis; Katherine Lajkosz; Neil Fleshner Journal: Cancer Med Date: 2021-03-12 Impact factor: 4.452
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859