Predictors of referral for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer and changes in practice over time

Abstract

Introduction: 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. 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.

Suboptimal use of neoadjuvant chemotherapy in radical cystectomy patients: A population-based study

“…In that patient cohort , the rates of NC increased from 7.6% in 2006 to 20.9% in 2010. Similar to our study, Gotto et al 19 recorded increased rates of NC administration over time according to different Canadian centres between 2007 and 2011. Higher rate of NC in the Zaid et al report may relate to age differences between the current populations and theirs.…”

A pilot phase II study of neoadjuvant triplet chemotherapy regimen in patients with locally advanced resectable colon cancer

“…Neoadjuvant chemotherapy has many advantages and is widely utilized in gastric, breast and bladder cancer (6-8). In certain stages of the disease, it is substantially more effective than postoperative therapy (9).…”

Population‐based analysis of perioperative chemotherapy use, interventions requiring hospitalization and atheroembolic events among patients with non‐metastatic muscle‐invasive bladder cancer

“…The sizable amount of patients whom commence chemotherapy and never make it to RC is an interesting group to hypothesize upon. These findings call into question the generalizability of prior publications in this space that have utilized the actual RC as a start point for cohort assembly 19‐21,29 . When comparing predictors of initiation versus completion of NC, we see a significant difference in baseline characteristics.…”

“…Possible explanations for a moderate level of completion could be a continued skepticism toward the risk/benefits of NC. Multidisciplinary tumor boards are shown to improve use of NC in other malignancies and may serve as an impetus for wider academic adoption of concerted meetings for bladder cancer patients 29,30 . Additionally, many patients are simply not eligible for this multimodal treatment due to competing comorbidities.…”