Patterns of referral for perioperative chemotherapy among patients with muscle-invasive bladder cancer: a population-based study

Purpose — Reasons for low uptake of perioperative chemotherapy for muscle-invasive bladder cancer are not well described. Herein, the authors 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.