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Delayed surgery decreases bladder cancer survival

Posted on: Thursday, 13 April 2006, 09:48 CDT

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.

Source: REUTERS

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