Booth Christopher M, Siemens David Robert, Peng Yingwei, Mackillop William J
Division of Cancer Care and Epidemiology, Queen׳s University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen׳s University, Kingston, Canada.
Department of Oncology, Queen׳s University, Kingston, Canada; Department of Urology, Queen׳s University, Kingston, Canada.
Urol Oncol. 2014 Nov;32(8):1200-8. doi: 10.1016/j.urolonc.2014.05.012. Epub 2014 Jun 23.
Reasons for low uptake of perioperative chemotherapy for muscle-invasive bladder cancer are not well described. Herein, we report referral patterns from urology to medical oncology (MO) in Ontario, Canada, and subsequent use of chemotherapy.
Electronic treatment records were linked to the Ontario Cancer Registry to describe referral patterns and use of neoadjuvant/adjuvant chemotherapy (NACT/ACT) among patients with muscle-invasive bladder cancer treated with cystectomy in Ontario from 1994 to 2008. Logistic regression identified factors associated with referral to MO and use of NACT/ACT.
Overall, 18% (520/2,944) of patients were seen by MO before cystectomy, and 25% (128/520) of referred cases were treated with NACT. Among patients not treated with NACT or radiation, 39% (1,085/2,809) were seen by MO following cystectomy; 51% (548/1,085) of referred patients had ACT. There was wide geographic variation in MO referral rates before (range: 5%-40%) and after cystectomy (range: 26%-59%). Patients seen by MO from 2004 to 2008 were more likely to receive ACT (57%) compared with patients in earlier years (41% in 1994-1998 and 46% in 1999-2003, P<0.001).
Lack of referral to MO is an important barrier to use of NACT/ACT. Upstream decision making by urologists is an important target in future knowledge translation.
肌肉浸润性膀胱癌围手术期化疗采用率低的原因尚未得到充分描述。在此，我们报告了加拿大安大略省从泌尿外科转诊至医学肿瘤学（MO）的模式以及随后的化疗使用情况。
将电子治疗记录与安大略癌症登记处相链接，以描述1994年至2008年在安大略省接受膀胱切除术的肌肉浸润性膀胱癌患者的转诊模式和新辅助/辅助化疗（NACT/ACT）的使用情况。逻辑回归确定了与转诊至MO以及使用NACT/ACT相关的因素。
总体而言，18%（520/2944）的患者在膀胱切除术前行MO会诊，其中25%（128/520）的转诊病例接受了NACT治疗。在未接受NACT或放疗的患者中，39%（1085/2809）在膀胱切除术后接受了MO会诊；51%（548/1085）的转诊患者接受了ACT治疗。MO转诊率在膀胱切除术之前（范围：5%-40%）和之后（范围：26%-59%）存在广泛的地域差异。与早期患者相比，2004年至2008年接受MO会诊的患者更有可能接受ACT治疗（57%），早期患者中1994 - 1998年为41%，1999 - 2003年为46%，P<0.001）。
未转诊至MO是使用NACT/ACT的一个重要障碍。泌尿外科医生的上游决策是未来知识转化的一个重要目标。
