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. 1991 Aug 24;303(6800):437–440. doi: 10.1136/bmj.303.6800.437

Survival with bladder cancer, evaluation of delay in treatment, type of surgeon, and modality of treatment.

M C Gulliford 1, A Petruckevitch 1, P G Burney 1
PMCID: PMC1670565  PMID: 1912834

Abstract

OBJECTIVE--To determine whether length of delay before treatment; specialty and grade of the surgeon; and use made of surgery, radiotherapy, and chemotherapy influenced the survival of patients with cancer of the bladder, after adjusting for case severity. DESIGN--Retrospective cohort study. SETTING--South East and South West Thames health regions. PATIENTS--609 men aged under 75 resident in the South Thames regions who had been registered as new cases of bladder cancer in 1982, 35 of whom were excluded, leaving 574 eligible patients. Analysis was based on 75% retrieval rate for case notes. MAIN OUTCOME MEASURES--Duration of survival from date of diagnosis of the bladder tumour. RESULTS--10 prognostic variables were used to adjust for case severity. The median delay from referral to first treatment was 48 (interquartile range 27-84) days. Treatment after a short delay was associated with shorter survival because of the early treatment of more severe cases. Consultants treated 68% of patients, trainee surgeons treated less severe cases. Initial treatment was by a urologist in 67% of cases, but the specialty of the surgeon was not associated with prognosis. The associations of radiotherapy, cystectomy, and systemic chemotherapy with survival were interpreted in terms of selection bias as well as therapeutic effect. CONCLUSION--Case severity was the most important influence on survival and influenced length of delay before treatment, grade and specialty of the surgeon, and main treatment allocation. After adjusting for case severity variations in these processes of care were not strongly associated with variations in survival.

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Selected References

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  1. Abel P. D. Prognostic indices in transitional cell carcinoma of the bladder. Br J Urol. 1988 Aug;62(2):103–109. doi: 10.1111/j.1464-410x.1988.tb04286.x. [DOI] [PubMed] [Google Scholar]
  2. Aso Y., Anderson L., Soloway M., Bouffioux C., Chisholm G., Debruyne F., Kawai T., Kurth K. H., Maru A., Straffon W. G. Prognostic factors in superficial bladder cancer. Prog Clin Biol Res. 1986;221:257–269. [PubMed] [Google Scholar]
  3. Bishop M. C. The dangers of a long urological waiting list. Br J Urol. 1990 May;65(5):433–440. doi: 10.1111/j.1464-410x.1990.tb14781.x. [DOI] [PubMed] [Google Scholar]
  4. Charlton J. R., Hartley R. M., Silver R., Holland W. W. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983 Mar 26;1(8326 Pt 1):691–696. doi: 10.1016/s0140-6736(83)91981-5. [DOI] [PubMed] [Google Scholar]
  5. Dubois R. W., Brook R. H., Rogers W. H. Adjusted hospital death rates: a potential screen for quality of medical care. Am J Public Health. 1987 Sep;77(9):1162–1166. doi: 10.2105/ajph.77.9.1162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dubois R. W., Rogers W. H., Moxley J. H., 3rd, Draper D., Brook R. H. Hospital inpatient mortality. Is it a predictor of quality? N Engl J Med. 1987 Dec 24;317(26):1674–1680. doi: 10.1056/NEJM198712243172626. [DOI] [PubMed] [Google Scholar]
  7. Green J., Wintfeld N., Sharkey P., Passman L. J. The importance of severity of illness in assessing hospital mortality. JAMA. 1990 Jan 12;263(2):241–246. [PubMed] [Google Scholar]
  8. Gulliford M. C., Petruckevitch A., Burney P. G. Hospital case notes and medical audit: evaluation of non-response. BMJ. 1991 May 11;302(6785):1128–1129. doi: 10.1136/bmj.302.6785.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hope-Stone H. F., Oliver R. T., England H. R., Blandy J. P. T3 bladder cancer: salvage rather than elective cystectomy after radiotherapy. Urology. 1984 Oct;24(4):315–320. doi: 10.1016/0090-4295(84)90199-7. [DOI] [PubMed] [Google Scholar]
  10. Mameghan H., Fisher R. Invasive bladder cancer. Prognostic factors and results of radiotherapy with and without cystectomy. Br J Urol. 1989 Mar;63(3):251–258. doi: 10.1111/j.1464-410x.1989.tb05185.x. [DOI] [PubMed] [Google Scholar]
  11. Mommsen S., Aagaard J., Sell A. Presenting symptoms, treatment delay and survival in bladder cancer. Scand J Urol Nephrol. 1983;17(2):163–167. doi: 10.3109/00365598309180162. [DOI] [PubMed] [Google Scholar]
  12. Park R. E., Brook R. H., Kosecoff J., Keesey J., Rubenstein L., Keeler E., Kahn K. L., Rogers W. H., Chassin M. R. Explaining variations in hospital death rates. Randomness, severity of illness, quality of care. JAMA. 1990 Jul 25;264(4):484–490. [PubMed] [Google Scholar]
  13. Raghavan D., Shipley W. U., Garnick M. B., Russell P. J., Richie J. P. Biology and management of bladder cancer. N Engl J Med. 1990 Apr 19;322(16):1129–1138. doi: 10.1056/NEJM199004193221607. [DOI] [PubMed] [Google Scholar]
  14. Shearer R. J., Chilvers C. F., Bloom H. J., Bliss J. M., Horwich A., Babiker A. Adjuvant chemotherapy in T3 carcinoma of the bladder. A prospective trial: preliminary report. Br J Urol. 1988 Dec;62(6):558–564. doi: 10.1111/j.1464-410x.1988.tb04426.x. [DOI] [PubMed] [Google Scholar]
  15. Silman A. J., Evans S. J. Regional differences in survival from cancer. Community Med. 1981 Nov;3(4):291–297. [PubMed] [Google Scholar]
  16. Soloway M. S. Selecting initial therapy for bladder cancer. Cancer. 1987 Aug 1;60(3 Suppl):502–513. doi: 10.1002/1097-0142(19870801)60:3+<502::aid-cncr2820601512>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  17. The NHS needs a change. Lancet. 1986 Jun 14;1(8494):1385–1386. [PubMed] [Google Scholar]
  18. WALLACE D. M., HARRIS D. L. DELAY IN TREATING BLADDER TUMOURS. Lancet. 1965 Aug 14;2(7407):332–334. doi: 10.1016/s0140-6736(65)90298-9. [DOI] [PubMed] [Google Scholar]

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