In:
Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 10, No. 1-2 ( 2016-02-16), p. 25-
Abstract:
〈 p 〉 〈 strong 〉 Introdcution: 〈 /strong 〉 While level 1 evidence supports the use of neo-adjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer (MIBC), its uptake has been underwhelming even in academic centres. Our aim was to determine if the initiation of a multidisciplinary bladder cancer clinic (MDBCC) in 2008 at our institution, where patients are assessed simultaneously by bladder cancer-focused urologists and radiation oncologists with easy access to a medical oncologist, was associated with an increased use of NAC. 〈 /p 〉 〈 p 〉 〈 strong 〉 Methods 〈 /strong 〉 : Patients with MIBC initiating treatment between July 2000 and June 2013 were identified and classified by academic year (July 1 to June 30). Time-series analyses using interventional autoregressive integrated moving average (ARIMA) models with ramp intervention functions were then conducted. A sensitivity analysis was performed on clinical N0 patients. 〈 /p 〉 〈 p 〉 〈 strong 〉 Results 〈 /strong 〉 : The cohort included 278 patients: 168 from 2000-2007 and 110 from 2008-2012 (academic years). Forty-two (15.1%) patients received NAC and 74 (26.6%) received adjuvant chemotherapy (AC). Overall the proportion of patients receiving NAC increased from 7.7% before the MDBCC to 47.6% in 2012 (Interventional ARIMA p=0.036). The results were similar when restricting to cN0 patients (p & lt;0.001). NAC use gradually increased over time regardless of MDBCC attendance, although the proportion of patients receiving NAC appears to have risen more sharply among MDBCC attendees. 〈 /p 〉 〈 strong 〉 Conclusions 〈 /strong 〉 : At our institution, the initiation of the MDBCC was temporally associated with increased use of NAC. In addition to multidisciplinary collaboration, having a critical mass of NAC physician advocates and support from institutional leaders are essential to the uptake of NAC. 〈 strong 〉 〈 /strong 〉
Type of Medium:
Online Resource
ISSN:
1920-1214
Language:
Unknown
Publisher:
Canadian Urological Association Journal
Publication Date:
2016
