Delaying cystectomy appears to raise mortality risk

The study, from McGill University Health Center in Montreal, was an analysis of outcomes of pre-treatment delays in the province of Quebec.

"Delays in care have been a major concern throughout Canada and Quebec," said Nader Fahmy, MD, a uro-oncology research fellow at McGill. "What drives it are more patients and fewer resources."

Many studies have examined the impact of delays between transurethral resection of bladder tumor (TURBT) and cystectomies, several finding a strong positive relationship between these delays and increased mortality. The relationship between the first visit to a urologist after referral from a GP for potential bladder cancer and cystectomy had not been adequately investigated, Dr. Fahmy explained in an interview with Urology Times.

Key objectives of the study were to identify the lengths of various delays from the time a GP identified symptoms to the time the patient underwent cystectomy. To classify these delays, investigators looked at the following components of delay:

Investigators analyzed relationships between these parameters and mortality using data extracted from billing records provided by the Régie Assurance Maladie du Québec (RAMQ), the Province of Quebec Health Registry. Dates of relevant visits and procedures, urologists' names, and the sex, age, and date of death of patients were recorded.

Growing wait, growing risk

Of 1,633 patients who were treated between 1990 and 2002, 25,862 patient visits were recorded. The average patient age was 66 years, with a male:female ratio of 2.6:1.

"From the start of the study in 1990 until 2002, the median delay from the first GP visit and [the actual] cystectomy increased by more than 2 months, going from 58 to 120 days, with a median overall delay of 93 days," Dr. Fahmy said.

Investigators found that the median delay from the first GP visit and the urologist visit doubled, from 58 days to 120 days. Further, median delays for all dimensions increased at least twofold.

"After being seen by a urologist and undergoing a cystectomy, patients have to wait for more than 2 months, with a median overall delay of 69 days," Dr. Fahmy reported.

He said that wait times have increased from a median of 34 to 70 days between the urology visit and CT, with a median overall delay of 44 days. Wait times for cystectomy following cystoscopy also rose, reaching a median of 54 days. Patients had to wait for a median of 33 days between undergoing a TURBT and cystectomy.

The researchers discovered a 40% increase in the risk of mortality among patients who were required to wait for more than 84 days before they underwent cystectomy. Those who waited less than 25 days had a twofold increase in their risk of death. The risk of mortality was 60% higher for patients age 70 years or older.