346 Background: Population-based data suggest an association between timely treatment (<3 months) and improved survival in patients undergoing radical cystectomy (RC). Hypothesizing that care transitions at the time of hospital referral may delay timely treatment in patients with muscle invasive bladder cancer (MIBC), our objective was to identify the association between care transitions and treatment delay ≥3 months using a large national tumor registry. Methods: Using the National Cancer Database, all patients with stage ≥II urothelial carcinoma treated with RC from 2003-2010 were identified. A care transition was defined as a change in hospital from diagnosis to first course of treatment. A logistic regression model was used to test the association between care transition and treatment delay (from diagnosis to RC or initiation of neoadjuvant chemotherapy), adjusting for year, demographic, clinicopathologic, and hospital characteristics. Results: Of 22,251 patients identified, 14.2% of patients experienced a treatment delay of ≥3 months. Further, this proportion increased over the study period (13.5% [2003-2006] versus 14.8% [2007-2010], p=0.01). 19.4% of patients undergoing a care transition experienced a delay to definitive treatment compared to 10.7% of patients diagnosed and treated at the same hospital (p<0.001). The proportion of patients experiencing a care transition increased over the study period (37.4% [2003-2006] versus 42.3% [2007-2010], p<0.001). Following adjustment, patients were more likely to experience a treatment delay when undergoing a care transition (OR 2.0 [CI 1.8-2.2]). Additional covariates associated with treatment delay included African American race (OR 1.5 [CI 1.3-1.7]), Hispanic ethnicity (OR 1.6 [CI 1.3-1.9]), insurance status (Medicaid OR 1.4 [CI 1.1-1.7], Medicare OR 1.2 [CI 1.08-1.34], no insurance OR 1.3 [CI 1.07-1.54]), and Charlson comorbidity count ≥2 (OR 1.3 [CI 1.08-1.45]). Conclusions: Patients with MIBC who experienced a care transition between diagnosis and treatment hospitals were more likely to experience a treatment delay of ≥3 months. Strategies to expedite care transitions at the time of hospital referral may be a means to improve quality of care.
Identification of Neoadjuvant Chemotherapy Response in Muscle-Invasive Bladder Cancer by Fourier-Transform Infrared Micro-Imaging
