A population-based study of patterns of care for muscle-invasive bladder cancer in Sweden.
OBJECTIVE
To analyse the management of muscle-invasive bladder cancer in a population-based national register, and specifically to investigate the role of curative therapy (i.e. cystectomy or radiotherapy) in relation to patient, tumour and hospital characteristics.


METHODS
The Swedish Bladder Cancer Register covers more than 90% of all patients in the country who have been diagnosed with such disease since 1997. Results from 1997-2003 were analysed regarding curative-intent treatment given within 3-6 months of diagnosis of muscle-invasive bladder cancer.


RESULTS
In total, 3463 patients with clinical T2-T4 bladder cancer were included in the analysis. Of those patients, 1426 (41%) received curative-intent treatment in the form of radiotherapy (285, 20%) or cystectomy (1141, 80%). Male gender, age < 76 years, favourable TNM category and registration at a high-volume hospital were associated with such treatment. Curative-intent treatment was given to significantly more patients registered at high-volume hospitals (1003/2227, 45%) than at low-volume hospitals (423/1235, 34%) (chi(2)=37.7, p<0.00001). Cystectomy was performed more often in those registered at high-volume than at low-volume hospitals (826/2227, 37%, and 316/1235, 26%, respectively, chi(2)=47.3, p<0.00001).


CONCLUSIONS
Lower rates of curative-intent treatment were found in patients registered at low-volume than at high-volume facilities, and the same was seen when comparing females with males, and patients aged 76-80 years with younger patients. Since many of these bladder cancer patients were registered at and eventually treated at hospitals handling fewer than 10 such cases annually, it seems desirable to concentrate treatment of this disease at more specialized centres.
Jahnson
Staffan
S
Department of Urology, University Hospital, Linköping, Sweden. Staffan.Jahnson@lio.se
Damm
Ole
O
Hellsten
Sverker
S
Holmäng
Sten
S
Liedberg
Fredrik
F
Ljungberg
Börje
B
Malmström
Per-Uno
PU
Månsson
Wiking
W
Strömberg
Fredrik
F
Wijkstöm
Hans
H
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010346:Patient Care Management / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011878:Radiotherapy; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*