Neoadjuvant chemotherapy administration and time to cystectomy for muscle-invasive bladder cancer: An evaluation of transitions between academic and community settings.

Rose TL, Deal AM, Basch E, Godley PA, Rathmell WK, Kim WY, Whang YE, Dunn MW, Wang A, Chen RC, Nielsen ME, Pruthi RS, Wallen EM, Woods ME, Smith AB, Milowsky MI
Urol Oncol. 2015 33 (9): 386.e1-6

PMID: 26122712 · PMCID: PMC5084688 · DOI:10.1016/j.urolonc.2015.05.028

OBJECTIVES - Neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC.

METHODS - We performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community.

RESULTS - In all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280 mg/m(2) for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ.

CONCLUSION - Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.

Copyright © 2015 Elsevier Inc. All rights reserved.

MeSH Terms (19)

Academic Medical Centers Adult Aged Aged, 80 and over Antineoplastic Agents Carcinoma, Transitional Cell Community Medicine Cystectomy Disease-Free Survival Female Humans Male Middle Aged Neoadjuvant Therapy Patient Transfer Proportional Hazards Models Retrospective Studies Time-to-Treatment Urinary Bladder Neoplasms

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