title: Predictors of referral for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer and changes in practice over time.
abstract: BACKGROUND
  In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival.
  
  
  METHODS
  Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate.
  
  
  RESULTS
  Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6-50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030).
  
  
  CONCLUSIONS
  NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.
authors: Department of Surgery, Cumming School of Medicine, University of Calgary, Southern Alberta Institute of Urology, Calgary, AB;
authors: Geoffrey T
authors: GT
authors: Gotto
authors: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB; ; Alberta Health Services, Calgary, AB.
authors: Melissa A
authors: MA
authors: Shea-Budgell
authors: Alberta Health Services, Calgary, AB.
authors: M Sarah
authors: MS
authors: Rose
authors: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB; ; Alberta Health Services, Calgary, AB.
authors: J Dean
authors: JD
authors: Ruether