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Predictors of preoperative delays before radical cystectomy for bladder cancer in Q uebec, C anada: a population‐based study
Author(s) -
Santos Fabiano,
Dragomir Alice,
Kassouf Wassim,
Franco Eduardo L.,
Aprikian Armen
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12742
Subject(s) - medicine , bladder cancer , cystectomy , cohort , logistic regression , referral , retrospective cohort study , odds ratio , urology , population , cancer , surgery , demography , gynecology , family medicine , environmental health , sociology
Objectives To characterise and measure different components of preoperative delays experienced by patients with bladder cancer before radical cystectomy ( RC ) in the province of Q uebec, C anada and to identify the predictors of long waiting times. Methods We conducted a retrospective cohort study using the data of patients who underwent RC for bladder cancer between 2000 and 2009 in Q uebec. The cohort was obtained with the linkage of two provincial health databases: the R égie de l'assurance maladie du Q uébec database (data on medical services dispensed to Q uebec residents), and the F ichier des évenements démographiques de l’ I nstitut de la statistique du Q uébec database (demographic data on births and deaths). For the entire cohort, we determined several components of delay from first medical visit related to bladder cancer symptoms until RC . Predictors of long delays were analysed using logistic regression. Results We analysed a total of 2778 patients who met the inclusion criteria. The median urologist referral delay was 32 days. The median delays between first urologist visit and RC and between transurethral resection of bladder tumour ( TURBT ) to RC were 90 days and 46 days, respectively. The median overall delay was 116 days. All components of delay progressively increased from the decade of the 1990s to the decade of the 2000s. Male gender was a protective factor for several components of delay, which suggests that gender‐related variations may exist in the course of care for bladder cancer (odds ratio 0.67, 95% CI 0.50–0.89 for overall delay). Patient age and gender were associated with delayed urologist referral, delayed time to TURBT , and long overall waiting time. Factors related to the health system were associated with long cystoscopy delays. Conclusion Median preoperative delays among patients with bladder cancer have been increasing and remain unacceptably long. Patient's age, gender and type of hospital facility were associated with long waiting times.