title: Longer wait times increase overall mortality in patients with bladder cancer.
abstract: OBJECTIVE
  We used population level data to determine the impact of extended wait times on the survival of patients who underwent radical cystectomy for bladder cancer.
  
  
  METHODS
  We identified 2,535 patients who underwent cystectomy for bladder cancer in Ontario, Canada between 1992 and 2004 using administrative databases. A Cox proportional hazards model accounting for patient, pathological and health services variables that could affect wait times was created to assess the impact of wait time on survival. The tumor stage specific impact of waiting for cystectomy was also assessed. Cox regression analysis that modeled wait time using cubic splines was used to determine a maximum wait time within which optimal care can be provided.
  
  
  RESULTS
  Median wait time from transurethral bladder resection to cystectomy was 50 days. Unadjusted and adjusted analyses demonstrated that prolonged wait times were significantly associated with a lower overall survival rate. The relative hazard of death with increasing wait times appeared greater for low stage vs high stage cancers. The cubic splines regression analysis revealed that the risk of death began to increase after 40 days.
  
  
  CONCLUSIONS
  Treatment delay between transurethral bladder tumor resection and radical cystectomy resulted in worse overall survival. The effect of wait time was greatest in lower stage lesions. The suggested maximum wait time from transurethral bladder tumor resection to cystectomy was 40 days. Further studies assessing disease-free survival are required to corroborate these findings.
authors.affiliation: Department of Health Policy, Management and Evaluation, University Health Network, Toronto, Canada. girish1975@gmail.com
authors.forename: Girish S
authors.initials: GS
authors.lastname: Kulkarni
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
mesh_terms: D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery; D014850:Waiting Lists