Cited by 123Bladder and Urothelial Cancer TreatmentsUrinary and Genital Oncology StudiesUrinary Bladder and Prostate Research

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Longer Wait Times Increase Overall Mortality in Patients With Bladder Cancer

Kulkarni, Girish S., Urbach, David R., Austin, Peter C., Fleshner, Neil E., Laupacis, Andreas·2009·Journal of Urology

DOI 10.1016/j.juro.2009.06.041

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Abstract

PURPOSE: We used population level data to determine the impact of extended wait times on the survival of patients who underwent radical cystectomy for bladder cancer. MATERIALS AND METHODS: We identified 2,535 patients who underwent cystectomy for bladder cancer in Ontario, Canada between 1992 and 2004 using administrative databases. A Cox proportional hazards model accounting for patient, pathological and health services variables that could affect wait times was created to assess the impact of wait time on survival. The tumor stage specific impact of waiting for cystectomy was also assessed. Cox regression analysis that modeled wait time using cubic splines was used to determine a maximum wait time within which optimal care can be provided. RESULTS: Median wait time from transurethral bladder resection to cystectomy was 50 days. Unadjusted and adjusted analyses demonstrated that prolonged wait times were significantly associated with a lower overall survival rate. The relative hazard of death with increasing wait times appeared greater for low stage vs high stage cancers. The cubic splines regression analysis revealed that the risk of death began to increase after 40 days. CONCLUSIONS: Treatment delay between transurethral bladder tumor resection and radical cystectomy resulted in worse overall survival. The effect of wait time was greatest in lower stage lesions. The suggested maximum wait time from transurethral bladder tumor resection to cystectomy was 40 days. Further studies assessing disease-free survival are required to corroborate these findings.

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Authors: Kulkarni, G. S., Urbach, D. R., Austin, P. C., Fleshner, N. E., & Laupacis, A.
Affiliations: University Health Network (CA)
St. Michael's Hospital (CA)
ORCID: Kulkarni, Girish S.
Urbach, David R.
Austin, Peter C.
Fleshner, Neil E.
Laupacis, Andreas
Venue: Journal of Urology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-10
Volume: 182
Issue: 4
Pages: 1318-1324
ISSN: 0022-5347 (ISSN-L)
1527-3792
DOI: 10.1016/j.juro.2009.06.041
OpenAlex: W2031571951
Cited by: 123
References: 20
Citations by year: 2026: 6 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 11 · 2019: 7 · 2018: 10 · 2017: 12 · 2016: 3 · 2015: 4 · 2014: 11 · 2013: 14 · 2012: 6
FWCI: 5.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Journal of Urology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Bladder and Urothelial Cancer Treatments
Health Sciences › Medicine › Surgery › Urinary and Genital Oncology Studies
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords: bladder cancer, radical cystectomy, treatment delay, waiting time, overall survival, transurethral resection, tumor stage, health care access
MeSH terms: Aged, Urinary Bladder Neoplasms, Female, Humans, Male, Retrospective Studies, Time Factors, Waiting Lists, Cystectomy, Survival Rate, Survival Analysis

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Longer Wait Times Increase Overall Mortality in Patients With Bladder Cancer

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