title: Regional differences in practice patterns and outcomes in patients treated with radical cystectomy in a universal healthcare system.
abstract: BACKGROUND
  Our objective is to assess differences in practice patterns and outcomes across 3 regions in bladder cancer patients treated with radical cystectomy under a universal healthcare system.
  
  
  METHODS
  In total, we included 2287 patients treated with radical cystectomy at 8 Canadian centres from 1998 to 2008. Variables included various clinico-pathologic parameters, recurrence, and death stratified into different regions.
  
  
  RESULTS
  In total, 1105 patients were from the east region (group 1), 601 from the centre region (group 2), and 581 from the west region of Canada (group 3). The median follow-up of groups 1, 2, and 3 was 22.1, 17.1, and 28.6 months, respectively. Although the overall rate of neoadjuvant chemotherapy was low (3.1%), rates were higher in group 2 compared with groups 1 and 3 (p = 0.07). Continent diversions and extended lymphadenectomy were performed in 23.5%, 8.5%, 23.9% and 39.7%, 27.7%, 12.6% across groups 1, 2, and 3, respectively. There were statistically significant differences in gender distribution, performance of lymphadenectomy, presence of concomitant carcinoma in situ and lymphovascular invasion across the 3 groups. There were no differences among the 3 geographical locations in terms of stage, surgical margin status, and use of adjuvant chemotherapy. The mean number of days from the transurethral resection of the bladder tumour to cystectomy was 50, 79, 69 days for groups 1, 2, 3, respectively (p = 0.0006). The 5-year overall survival was 53.6%, 66.8%, and 52.4% for groups 1, 2 and 3, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Significant variations in practice patterns were noted across different geographic regions in a universal healthcare system. Use of continent diversions, extended lymphadenectomy, and neoadjuvant chemotherapy remains low across all 3 regions. Treatment delays are significant.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, QC;
authors.forename: Bassel G
authors.initials: BG
authors.lastname: Bachir
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.forename: Eric
authors.initials: E
authors.lastname: Estey
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf