scholarly journals Use of radiotherapy for bladder cancer: A population-based study of evolving referral and practice patterns

2018 ◽  
Vol 13 (4) ◽  
Author(s):  
Xuejiao Wei ◽  
D. Robert Siemens ◽  
William J. Mackillop ◽  
Christopher M. Booth
Keyword(s):  
Bladder Cancer ◽  
Geographic Location ◽  
Multidisciplinary Care ◽  
Population Based ◽  
Definitive Treatment ◽  
Case Volume ◽  
Patient Factors ◽  
Curative Intent ◽  
Factors Associated ◽  
Radical Treatment

Introduction: Definitive treatment for muscle-invasive bladder cancer includes either cystectomy or radiotherapy (RT). We describe use of RT and radiation oncology (RO) referral patterns in the contemporary era. Methods: The Ontario Cancer Registry and linked records of treatment were used to identify all patients who received cystectomy or RT for bladder cancer from 1994–2013. Physician billing records were linked to identify RO consultation before radical treatment. Multilevel logistic regression models were used to examine patient factors and physician-level variation in referral to RO and use of RT. Results: A total of 7461 patients underwent cystectomy or RT for bladder cancer from 1994–2013; 5574 (75%) had cystectomy and 1887 (25%) had RT. Use of RT decreased from 43% (126/289) in 1994 to 23% (112/478) in 2008 and remained stable from 2009– 2013 (23%, 507/2202). RO referral rate among all cases decreased from 46% (134/289) in 1994 to 30% (143/478) in 2008; however, the rates began to rise in the contemporary era from 31% (137/442) in 2009 to 37% (165/448) in 2013 (p=0.03). Patient factors associated with use of RT include older age, greater comorbidity, and geographic location. Surgeon-level factors associated with greater preoperative referral to RO include higher surgeon case volume and practicing in a teaching hospital. Conclusions: One-quarter of patients treated with curative intent therapy for bladder cancer receive RT. While referral rates to RO are increasing, future data will identify the extent to which this has altered practice. Collaborative efforts promoting multidisciplinary care and RO consultation before radical treatment are warranted.

scholarly journals Utilization of Radiotherapy for Bladder Cancer: Evolving referral and practice patterns in the general population

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Shelly Wei ◽  
Christopher Booth ◽  
Robert Siemens
Keyword(s):  
Bladder Cancer ◽  
Practice Patterns ◽  
Multidisciplinary Care ◽  
Referral Rate ◽  
Routine Practice ◽  
Hospital Level ◽  
Case Volume ◽  
Curative Intent ◽  
Treatment Practice ◽  
Logistic Regression Models

IntroductionDefinitive treatment for muscle invasive bladder cancer (MIBC) includes either cystectomy or radical radiotherapy (RT). Despite the growing evidence suggesting that cystectomy and RT may offer comparable survival benefit, utilization of RT and referral rate to radiation oncology (RO) have historically been low in routine practice. Objectives and ApproachThe aims were to describe the use of RT and RO referral patterns in the contemporary era. A retrospective cohort study was conducted by linking administrative treatment records with the Ontario Cancer Registry to identify all patients who received treatment with curative intent for bladder cancer in Ontario from 1994-2013. Physician billing records were linked to identify RO consultation before radical treatment. Practice patterns in the contemporary era (2009-2013) were compared with data from 1994 to 2008. Multilevel (patient-, surgeon- and hospital-level) logistic regression models were used to examine sociodemographic and organizational variation in referral to RO. ResultsIn total, 7461 patients underwent cystectomy or RT for bladder cancer in Ontario from 1994-2013; 5574 (75%) had primary cystectomy and 1887 (25%) primary had RT. Use of RT decreased from 43% in 1994 to 23% in 2008 and remained stable during 2009-2013 (23%). RO referral rate among all cases decreased from 46% in 1994 to 30% in 2008; however, the rates began to rise in the contemporary era from 31% in 2009 to 37% in 2013. A similar trend was seen in preoperative referral rate among patients treated with cystectomy (11% in 1994-1998, 9% in 1999-2008, and 14% in 2009-2013). Patient, surgeon, and hospital-level factors associated with preoperative referral to RO include older age, year of cystectomy, higher surgeon case volume, and teaching hospital. Conclusion/ImplicationsA minority of patients underwent curative intent therapy for bladder cancer received RT. Recent data suggest that referral rates to RO are increasing; future data will identify the extent to which this has altered practice. Collaborative efforts promoting multidisciplinary care and RO consultation at the urologist and hospital-level are warranted.

Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in Uruguay: A population-based study.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 53-53
Author(s):  
Santiago Fontes ◽  
Ana Marín-Jiménez ◽  
Megan Berry ◽  
Mauricio Cuello ◽  
Juan Carlos Sánchez ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Population Based ◽  
Stage Iii ◽  
Disease Stage ◽  
Curative Intent ◽  
Factors Associated

53 Background: Despite surgery, the 5-year risk of systemic recurrence of colorectal cancer (CRC) in the absence of any further therapy is approximately 50 % for those with lymph node involvement and 20 ─ 30 % if the lymph nodes are negative. Adjuvant chemotherapy contributes to improved disease-free and overall survival for node-positive (stage III) or high-risk node negative (stage IIB) colon cancer. Similar benefits are observed for adjuvant chemoradiotherapy in rectal cancer. Previous research shows varied rates of adherence to published adjuvant chemotherapy Clinical Practice Guidelines (CPGs) for CRC, although population-based data is scarce. Purpose: The aim of this analysis was to assess adherence rates to adjuvant chemotherapy prescription within 16 weeks of surgery according to local and international CPGs for CRC patients treated with curative intent between 2008 and 2019 at the Uruguayan National Cancer Institute. Data regarding factors associated with chemotherapy receipt beyond 16 weeks from surgery and chemotherapy non receipt was also retrieved and analysed. Methods: We retrospectively reviewed medical and pathology reports of 833 patients diagnosed with CRC at our institution. Patients with stages IIB or III CRC who underwent curative-intent surgery were identified and included in the present analysis. A 16-week benchmark timeline for treatment initiation from date of surgery was considered. Fisher’s exact test was used to determine factors independently associated with receipt of chemotherapy and meeting the 16-week benchmark (p 0.05). Results: A total of 400 patients were identified of which 72% had peritoneal colorectal tumors and 28% had sub-peritoneal rectal tumors. Approximately 70% of the latter group received neoadjuvant chemo-radiotherapy. Considering the total cohort, 61% received adjuvant chemotherapy. Factors predicting chemotherapy receipt in the peritoneal colorectal group were age ≤ 70 and stage III disease. In the sub-peritoneal rectal group no significant effect was found. The 16-week benchmark was met in 72% (175) of those receiving chemotherapy and 70.6% (167) completed 6 months of systemic adjuvant treatment. A total of 156 patients (39%) did not receive adjuvant chemotherapy. The factors predicting chemotherapy non receipt were age > 70 and stage IIB in the peritoneal colorectal group. Conclusions: This analysis of adherence to CPGs identified several factors associated with chemotherapy non receipt and chemotherapy receipt outside of timeline benchmarks from date of curative-intent surgery in Montevideo, Uruguay. The two main factors significantly associated with chemotherapy non receipt were advanced age and lower disease stage. To our knowledge, our data is the first to elucidate these specific factors in the Uruguayan CRC patient population.

Factors associated with perioperative systemic chemotherapy for bladder cancer: A population based study

2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 4701-4701 ◽  
Author(s):  
J. M. McKiernan ◽  
G. J. Decastro ◽  
S. Gilbert ◽  
V. Grann ◽  
C. A. Olsson ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Systemic Chemotherapy ◽  
Population Based ◽  
Population Based Study ◽  
Factors Associated

The role of neoadjuvant chemotherapy in muscle invasive bladder cancer and correlation of clinical outcome with translational studies

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15551-15551
Author(s):  
S. A. Hussain ◽  
D. Ward ◽  
D. H. Palmer ◽  
D. Barton ◽  
V. Veeranna ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Residual Disease ◽  
Invasive Bladder Cancer ◽  
Definitive Treatment ◽  
Muscle Invasive Bladder Cancer ◽  
Serum Proteome ◽  
Radical Treatment ◽  
Early Progression ◽  
Translational Studies ◽  
Muscle Invasive

15551 Background The aim of this study was to investigate the outcome in patients with muscle-invasive bladder cancer (MIBC) receiving neo-adjuvant chemotherapy (neo-CT) prior to organ-preservation (chemo-radiation) or cystectomy. Additional translational studies were performed. Methods Patients with stage T2-T4, N0, M0 TCC bladder with calculated GFR =40ml/min were eligible. Neo-CT comprised gemcitabine (1,000 mg/m2 d1, d8, q21) plus cisplatin (35 mg/m2 d1, d8, q21) for 4 cycles . Following chemotherapy (CT) patients underwent surgery or radiotherapy (RT) with or without chemotherapy (CRT) treatment based on response to neo-CT and clinician and patient preference. Serial blood samples were collected for proteomic analysis. Results 20 patients have been recruited : 18 males 2 females; median age 70 years (range 47–86); stage T2; 9, T3A; 7, T3B; 4, all G3. 1 patient progressed before CT. 61 cycles of CT have been administered. Treatment has been well tolerated with only 1 neutropenic sepsis episode. 3 of 20 patients developed early progression and did not receive radical treatment. For the remaining 17 patients, choice of definitive treatment (surgery vs. RT/CRT) was based on response to neo-CT. 6 patients with residual disease at post-neo CT cystoscopy underwent surgery. 11/19 (58%) patients had a complete response (CR) to neo-CT, 9 of whom were treated by RT/CRT and 2 patients with pCR declined radical treatment (both alive at 10 and 19 months follow-up (FU)). At median FU of 12 months, 3/6 patients treated surgically and 2/9 patients treated by RT/CRT have died. 1-year survival by intention to treat analysis was 70%. We have used SELDI using the IMAC protein chip array to generate proteomic profiles of the patient sera collected to date. Although the number of samples is limited, the data suggest that there are changes in the pre- chemotherapy serum proteome of 3 patients that developed early progression (relative to 8 patients with CR to neo-CT ). Conclusions Neo-CT is active and well tolerated in MIBC. Proteomic profiling may further improve patient selection. Early data show serum proteome analysis can detect markers of early progression, and may therefore help select patients for different modalities more appropriately. Recruitment is ongoing. No significant financial relationships to disclose.

Concurrent chemoradiotherapy (CRT) for bladder cancer: Practice patterns and outcomes in the general population.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16025-e16025
Author(s):  
Ketan Ghate ◽  
Kelly Brennan ◽  
Safiya Karim ◽  
William J. Mackillop ◽  
Christopher M. Booth
Keyword(s):  
Bladder Cancer ◽  
General Population ◽  
Propensity Score ◽  
Practice Patterns ◽  
Propensity Score Analysis ◽  
Single Agent ◽  
Routine Practice ◽  
Curative Intent ◽  
Factors Associated ◽  
Score Analysis

e16025 Background: Clinical trials have shown that CRT improves survival compared to RT alone in muscle invasive bladder cancer. We describe uptake of CRT and outcomes in routine practice. Methods: Electronic treatment records were linked to the population-based Ontario Cancer Registry to identify all patients treated with curative intent RT for bladder cancer in Ontario 1999-2013. Practice patterns were described in three eras: 1999-2003, 2004-2008, 2009-2013. Modified Poisson regression was used to analyze factors associated with use of CRT. Cox model and propensity score analysis were used to explore the association between CRT and overall (OS) and cancer-specific survival (CSS). Results: 1398 patients underwent curative intent RT during 1999-2013; median age was 79 and 75% (1050/1398) were male. Use of CRT increased over time: 33% (135/409) in 1999-2003, 35% (170/482) in 2004-2008, 46% (232/507) in 2009-2013 (p < 0.001). Among the 80% (431/537) of CRT cases with available drug details, the most common regimens were single-agent Cisplatin (57%, 245/431), single-agent Carboplatin (31%, 133/431) and 5-FU/Mitomycin (4%, 19/431). Factors associated with CRT include younger age (p < 0.001), male sex (p = 0.027), and lower co-morbidity (p < 0.001). There were large regional differences in use of CRT (range 14% to 85%, p < 0.001). Five year OS, CSS, and cystectomy-free survival rates among CRT cases were 34% (95%CI 30%-39%), 45% (95%CI 40%-50%), and 30% (95%CI 26%-34%). On adjusted analyses CRT was associated with superior survival compared to RT alone (OS HR 0.68, 95%CI 0.60-0.70; CSS HR 0.64, 95%CI 0.54-0.76). These results were consistent on propensity score analysis. There was a non-significant trend towards improved survival among all treated cases in 2009-2013 compared to 1999-2003 irrespective of chemotherapy delivery (OS HR 0.86, 95%CI 0.74-1.01; CSS HR 0.82, 95%CI 0.67-1.01). Conclusions: Although there has been substantial uptake of CRT in routine practice, utilization rates vary widely by region. CRT is associated with superior survival compared to RT alone and its uptake corresponded to a temporal trend towards improved survival among all treated cases in the general population.

scholarly journals Factors Associated with Refusal or Discontinuation of Treatment in Patients with Bladder Cancer: A Cohort Population-Based Study in Taiwan

2021 ◽  
Vol 18 (2) ◽  
pp. 618
Author(s):  
Nai-Tan Chang ◽  
Ying-Hsu Chang ◽  
Yu-Tung Huang ◽  
Shu-Ching Chen
Keyword(s):  
Bladder Cancer ◽  
Systemic Disease ◽  
Population Based ◽  
Northern Region ◽  
Stage Ii ◽  
Study Cohort ◽  
Cancer Stage ◽  
Psychological Burden ◽  
Factors Associated ◽  
Discontinuation Of Treatment

Cancer treatment causes adverse effects that lead to refusal or discontinuation of treatment. The purposes of this study were to identify 1) the factors associated with and 2) the reasons for refusing and discontinuing treatment in patients with bladder cancer (BC). We conducted a retrospective cohort study in patients diagnosed with BC in Taiwan from 1 January 2014 to 30 June 2019 using a linked cancer registry database. Of the 1247 BC patients in the study cohort, 2.1% reported refusing treatment. Patients with less education and those diagnosed at cancer stage II–IV were more likely to refuse treatment. The major reason for refusing treatment was “patient or the family considered patient’s poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment”. A total of 4.3% of BC patients reported discontinuing treatment. Patients not living in the northern region of Taiwan and those diagnosed at cancer stage II–IV were more likely to terminate treatment before completion. The major reason given for discontinuing treatment was inconvenient transportation. Sufficient social resources and supportive care can help BC patients cope with the physical and psychological burden of treatment.

scholarly journals Factors Associated With Clinical and Radiographic Severity in People With Osteoarthritis: A Cross-Sectional Population-Based Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Daniela Costa ◽  
Eduardo B. Cruz ◽  
Catarina Silva ◽  
Helena Canhão ◽  
Jaime Branco ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Geographic Location ◽  
Population Based ◽  
Clinical Severity ◽  
Depression Symptoms ◽  
Cross Sectional ◽  
Radiographic Severity ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
American College Of Rheumatology

Background: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity.Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011–2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models.Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55–64 years: odds ratio (OR) = 3.18; 65–74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65–74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity.Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.

scholarly journals Tumor cell invasion in blood vessels assessed by immunohistochemistry is related to decreased survival in patients with bladder cancer treated with radical cystectomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Birgitte Carlsen ◽  
Tor Audun Klingen ◽  
Bettina Kulle Andreassen ◽  
Erik Skaaheim Haug
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Regional Lymph Node ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Population Based ◽  
Blood Vessel Invasion ◽  
Curative Intent ◽  
Regional Lymph Nodes ◽  
Pathological Stages

Abstract Background Lymphovascular invasion (VI) is an established prognostic marker for many cancers including bladder cancer. There is a paucity of data regarding whether the prognostic significance of lymphatic invasion (LVI) differs from blood vessel invasion (BVI). The aim was to examine LVI and BVI separately using immunohistochemistry (IHC), and investigate their associations with clinicopathological characteristics and prognosis. A secondary aim was to compare the use of IHC with assessing VI on standard HAS (hematoxylin-azophloxine-saffron) sections without IHC. Methods A retrospective, population –based series of 292 invasive bladder cancers treated with radical cystectomy (RC) with curative intent at Vestfold Hospital Trust, Norway were reviewed. Traditional histopathological markers and VI based on HAS sections were recorded. Dual staining using D2–40/CD31 antibodies was performed on one selected tumor block for each case. Results The frequency of LVI and BVI was 32 and 28%, respectively. BVI was associated with features such as higher pathological stages, positive regional lymph nodes, bladder neck involvement and metastatic disease whereas LVI showed weaker or no associations. Both BVI and LVI independently predicted regional lymph node metastases, LVI being the slightly stronger factor. BVI, not LVI predicted higher pathological stages. BVI showed reduced recurrence free (RFS) and disease specific (DSS) survival in uni-and multivariable analyses, whereas LVI did not. On HAS sections, VI was found in 31% of the cases. By IHC, 51% were positive, corresponding to a 64% increased sensitivity in detecting VI. VI assessed without IHC was significantly associated with RFS and DSS in univariable but not multivariable analysis. Conclusions Our findings indicate that BVI is strongly associated with more aggressive tumor features. BVI was an independent prognostic factor in contrast to LVI. Furthermore, IHC increases VI sensitivity compared to HAS.

Factors associated with delayed time to adjuvant chemotherapy (AC) in stage III colon cancer: British Columbia Cancer Agency (BCCA) cohort experience.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 574-574
Author(s):  
Angela Chan ◽  
Ryan Woods ◽  
Sharlene Gill
Keyword(s):  
Colon Cancer ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Population Based ◽  
Current Standard ◽  
Urban Centre ◽  
Patient Factors ◽  
Time Intervals ◽  
Factors Associated ◽  
Resected Stage

574 Background: The current standard for resected stage 3 colon cancer after surgical resection is adjuvant 5FU-based chemotherapy. In trials, AC is mandated within 8 weeks after surgery, but outside the trial setting, up to 19% of patients do not receive treatment within 8 weeks. A recent meta-analysis confirms that AC started more than 8 weeks after surgery results in significantly decreased overall survival. Our objective was to ascertain logistical and patient factors associated with delayed AC delivery (defined as >56 days from surgery) in referred patients with resected stage 3 colon cancer. Methods: A population-based cohort of patients diagnosed with stage 3 colon cancer between January 2008 to December 2009 referred to the BCCA and treated with at least one cycle of AC were identified. Patient characteristics, and time intervals between surgery, referral, medical oncology consultation (MOC) and AC were assessed. Differences in patient characteristics and time intervals between patients were assessed using the Chi-square and Wilcoxon Rank-sum tests. Results: Median time from surgery to AC was 58 days with 54% of patients receiving AC beyond 56 days. Temporal differences were identified in all intervals between the between the timely and delayed groups (see table 1). Referral was most commonly initiated after hospital discharge. The only patient factors associated with delayed initiation included poorer ECOG status and being treated at the most urban centre within BCCA. Age, gender, comorbidity index, T stage and tumour location were not different between the groups. Conclusions: 54% of patients with stage 3 colon cancer had a delayed AC initiation. Process related delays at each step of the referral process need to be addressed including timely referral, MOC triage and addressing chemotherapy waitlists. [Table: see text]

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