An analysis of preoperative delays prior to radical cystectomy for bladder cancer in Quebec.
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).


CONCLUSIONS
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.
Department of Surgery (Urology), McGill University, Montréal, Que.
Nader
N
Fahmy
Wassim
W
Kassouf
Suganthiny
S
Jeyaganth
Moamen
M
Amin
Salaheddin
S
Mahmud
Jordan
J
Steinberg
Simon
S
Tanguay
Armen
A
Aprikian