title: Referral and treatment rates of neoadjuvant chemotherapy in muscle-invasive bladder cancer before and after publication of a clinical practice guideline.
abstract: BACKGROUND
  The objective of this study was to compare referral and treatment rates of neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer before and after publication of a clinical practice guideline.
  
  
  METHODS
  This was a retrospective comparative cohort study of 236 patients diagnosed with clinical stage >/= T2 bladder cancer in Alberta, Canada. Patients were divided into 2 groups based on the time of diagnosis relative to the publication of the Alberta Genitourinary Oncology Group Clinical Practice Guideline on Bladder Cancer (CPG), which recommends cisplatin-based neoadjuvant chemotherapy for muscle-invasive disease. The pre-CPG group included patients (n = 129) diagnosed prior to publication of the CPG (November 1, 2002 to October 31, 2004, inclusively). The post-CPG group included patients (n = 107) diagnosed after publication of the CPG (November 1, 2005 to October 31, 2007). There was an accrual blackout period of 6 months before and after the CPG release date. The primary analysis compared the two groups with respect to neoadjuvant chemotherapy referral rates, treatment-offered rates and treatment-administered rates.
  
  
  RESULTS
  Referral to medical oncology regarding neoadjuvant chemotherapy occurred in 2.3% and 23.4% of patients in the pre- and post-CPG groups, respectively (p < 0.01). Neoadjuvant chemotherapy was offered to 0.8% and 18.7% of patients in the pre- and post-CPG groups, respectively (p < 0.01). Neoadjuvant chemotherapy was administered to 0.8% and 14.0% of patients in the pre- and post-CPG groups, respectively (p < 0.01).
  
  
  CONCLUSIONS
  Neoadjuvant referral and treatment rates increased after publication of the CPG. However, overall referral and treatment rates remained low, which warrants additional exploration.
authors.affiliation: School of Medicine, Queen's University, Kingston, ON;
authors.forename: Brendan J W
authors.initials: BJ
authors.lastname: Miles
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Fairey
authors.forename: Michael
authors.initials: M
authors.lastname: Eliasziw
authors.forename: Eric P
authors.initials: EP
authors.lastname: Estey
authors.forename: Peter
authors.initials: P
authors.lastname: Venner
authors.forename: Daygen
authors.initials: D
authors.lastname: Finch
authors.forename: Kiril
authors.initials: K
authors.lastname: Trpkov
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Eigl