Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine Cancer Research UK. Cambridge Research Institute, Department of Uro-Oncology, Addenbrooke's Hospital Eastern Cancer Registration and Information Centre, Cambridge, UK.
Study Type - Prevalence (retrospective cohort) Level of Evidence 2b.
To examine the use of radiotherapy and radical surgery for bladder urothelial cell carcinoma (UCC) before, during and after national initiatives for reorganization of uro-oncology services.
Population-based data (1995-2006) from a cancer registry with stable coding practices were analysed. Bladder UCC was defined using relevant International Classification of Disease site and morphology codes. Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined.
Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%). Morphology and stage case mix remained stable during the study period. Radiotherapy use decreased significantly (from 31% in 1995-1998 to 22% in 2003-2006, P < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, P < 0.001), particularly among stage II-IV patients. The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%). Women were significantly more likely to present in stages II-IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06-1.40, P= 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72-0.99, P= 0.036).
Use of radical surgery in UCC invading bladder muscle increased and use of radiotherapy decreased during the study period, most probably reflecting the increasing availability of specialist surgical management. Sociodemographic variation in treatment was limited to lower use of radiotherapy in women. Further research should encompass treatment timeliness and other aspects of care quality, as well as exploring potential differences in endoscopic treatments for disease not invading bladder muscle.
Written by:
Barbiere JM, Saeb-Parsy K, Greenberg DC, Wright KA, Brown CH, Neal DE, Lyratzopoulos G.
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Reference: BJU Int. 2011 Feb 14. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.10058.x
PubMed Abstract
PMID: 21314887
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