title: Patterns of referral for perioperative chemotherapy among patients with muscle-invasive bladder cancer: a population-based study.
abstract: OBJECTIVE
  Reasons for low uptake of perioperative chemotherapy for muscle-invasive bladder cancer are not well described. Herein, we report referral patterns from urology to medical oncology (MO) in Ontario, Canada, and subsequent use of chemotherapy.
  
  
  METHODS
  Electronic treatment records were linked to the Ontario Cancer Registry to describe referral patterns and use of neoadjuvant/adjuvant chemotherapy (NACT/ACT) among patients with muscle-invasive bladder cancer treated with cystectomy in Ontario from 1994 to 2008. Logistic regression identified factors associated with referral to MO and use of NACT/ACT.
  
  
  RESULTS
  Overall, 18% (520/2,944) of patients were seen by MO before cystectomy, and 25% (128/520) of referred cases were treated with NACT. Among patients not treated with NACT or radiation, 39% (1,085/2,809) were seen by MO following cystectomy; 51% (548/1,085) of referred patients had ACT. There was wide geographic variation in MO referral rates before (range: 5%-40%) and after cystectomy (range: 26%-59%). Patients seen by MO from 2004 to 2008 were more likely to receive ACT (57%) compared with patients in earlier years (41% in 1994-1998 and 46% in 1999-2003, P<0.001).
  
  
  CONCLUSIONS
  Lack of referral to MO is an important barrier to use of NACT/ACT. Upstream decision making by urologists is an important target in future knowledge translation.
authors: Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen׳s University, Kingston, Canada. Electronic address: boothc@kgh.kari.net.
authors: Christopher M
authors: CM
authors: Booth
authors: Department of Oncology, Queen׳s University, Kingston, Canada; Department of Urology, Queen׳s University, Kingston, Canada.
authors: David Robert
authors: DR
authors: Siemens
authors: Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen׳s University, Kingston, Canada.
authors: Yingwei
authors: Y
authors: Peng
authors: Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen׳s University, Kingston, Canada; Department of Public Health Sciences, Queen׳s University, Kingston, Canada.
authors: William J
authors: WJ
authors: Mackillop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009864:Ontario / Q000453:epidemiology; D019990:Perioperative Care / Q000379:methods; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Bladder cancer; Chemotherapy; Health services research; Knowledge translation; Quality of care; Surgery