Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population based study.
OBJECTIVE
In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival.


METHODS
We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors.


RESULTS
During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051).


CONCLUSIONS
In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.
Mahmud
Salaheddin M
SM
Department of Oncology, McGill University, Montreal, Quebec, Canada.
Fong
Brian
B
Fahmy
Nader
N
Tanguay
Simon
S
Aprikian
Armen G
AG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*