April 13, 2006

Delayed surgery decreases bladder cancer survival

By Will Boggs, MD

NEW YORK (Reuters Health) - For patients newly diagnosed
with bladder cancer, delays of more than 3 months after the
initial diagnosis to surgery results in decreased survival, a
study shows.

"There currently are no standardized guidelines for the
appropriate timing of cystectomy" (surgical removal of the
bladder), Dr. Cheryl T. Lee from University of Michigan, Ann
Arbor, Michigan told Reuters Health. "However, there is growing
evidence that cystectomy should be performed within 3 months of
a diagnosis" of muscle-invasive disease.

The current study, she said, supports that "patients must
undergo cystectomy within 3 months of diagnosis or their
survival may be compromised."

Lee and colleagues evaluated the timing from the diagnosis
of bladder cancer to cystectomy in 214 consecutive patients to
assess its impact on survival.

By investigating each delay duration, the authors were able
to identify a delay of 93 days as the first cutoff point that
resulted in a significantly decreased overall survival and
so-called disease-specific survival.

Three-year disease-specific survival was 62 percent for
patients who underwent cystectomy within 93 days of diagnosis
and 49 percent for those who underwent surgery later, the
researchers note.

Three-year overall survival was 51 percent and 38 percent,
respectively, for patients operated within and beyond 93 days
of diagnosis.

Patients who had a cystectomy delay of more than 93 days
faced about twice the risk of patients who had an earlier
cystectomy of dying from any cause or from bladder cancer,
according to a multivariate analysis.

Nearly half the scheduling delays in patients who underwent
cystectomy after 93 days were related to clinical or research
appointments, the investigators say. Patient co-morbidities
accounted for 15 percent of the delays, and difficulty with
decision-making contributed to 12 percent of the delays.

"Rigorous coordination of preoperative counseling, medical
clearance, and patient education is required to permit an
efficient decision-making process and timely delivery of
surgery," Lee said.

SOURCE: The Journal of Urology April 2006.