title: Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists.
abstract: BACKGROUND
  Uptake of neoadjuvant chemotherapy (NC) for muscle invasive bladder cancer (MIBC) has been low despite evidence of a survival benefit. The primary aim of this study was to better understand why the rates are low and determine what factors specifically influence the decision to recommend NC for MIBC.
  
  
  METHODS
  A 31-question survey was emailed between 2009 and 2011 to medical oncologists belonging to the Canadian Association of Genitourinary Medical Oncologists (CAGMO); and to urologists belonging to the Canadian Urologic Oncology Group (CUOG). We gathered data on practice characteristics, referrals for NC, factors influencing NC use, and chemotherapy regimens offered. Responses were summarized using descriptive statistics.
  
  
  RESULTS
  In total, 26/30 (87%) medical oncologists and 25/84 (30%) urologists, who were primarily academic, completed the survey. Most clinicians (medical oncologists 96%, urologists 88%) recommended NC for MIBC, because they considered it to be the standard of care, but most medical oncologists saw ≤6 referrals annually. Performance status, presence of comorbidities and renal function were key considerations in offering NC. NC was not offered if performance status ≥2 (medical oncologists 38%, urologists 44%), age >80 (medical oncologists 46%, urologists 39%), or glomerular filtration rate ≤40 mL/min (medical oncologists 81%, urologists 50%).
  
  
  CONCLUSIONS
  Most academic clinicians in Canada believe that cisplatin-based combination NC is the standard of care for MIBC and recommend it for patients with adequate performance status and renal function. Using a multidisciplinary approach to treat this disease may be one strategy to increase referral rates for NC and uptake of NC.
authors.affiliation: University of Toronto, Toronto ON;
authors.forename: Tina
authors.initials: T
authors.lastname: Hsu
authors.affiliation: University of British Columbia, Vancouver BC;
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.affiliation: British Columbia Cancer Agency, Vancouver BC;
authors.forename: Kim N
authors.initials: KN
authors.lastname: Chi
authors.affiliation: Ottawa Regional Cancer Centre, Ottawa ON;
authors.forename: Christina M
authors.initials: CM
authors.lastname: Canil
authors.affiliation: British Columbia Cancer Agency, Vancouver BC;
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Eigl
authors.affiliation: University of Toronto, Toronto ON;
authors.forename: Girish
authors.initials: G
authors.lastname: Kulkarni
authors.affiliation: Cross Cancer Institute, Edmonton AB;
authors.forename: Scott
authors.initials: S
authors.lastname: North
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax NS;
authors.forename: Lori
authors.initials: L
authors.lastname: Wood
authors.affiliation: University of Toronto, Toronto ON;
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.affiliation: Princess Margaret Cancer Centre, Toronto ON.
authors.forename: Anthea
authors.initials: A
authors.lastname: Lau
authors.affiliation: Princess Margaret Cancer Centre, Toronto ON.
authors.forename: Tony
authors.initials: T
authors.lastname: Panzarella
authors.affiliation: Princess Margaret Cancer Centre, Toronto ON.
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar