Delay in surgery decreases survival for bladder cancer patients

Surgery should occur within 3 months of diagnosis; Scheduling is most common cause of delay, U-M researchers find

ANN ARBOR, Mich. -- Bladder cancer patients whose surgery was delayed for more than three months after their diagnosis were more likely to die from their disease than patients whose surgery was performed sooner, according to a study by researchers at the University of Michigan Comprehensive Cancer Center.

The study, published in the April Journal of Urology, looked at 214 patients diagnosed with muscle-invasive bladder cancer and treated with radical cystectomy, an operation in which the bladder is removed. The researchers found that patients whose surgery was delayed more than 93 days from the date of diagnosis had worse survival rates compared to patients whose surgery occurred in fewer than 93 days.

Thirty-nine percent of patients without a delay died, while 54 percent of patients with a delay died. The patients whose surgery was delayed lived on average only one year, and their three-year survival rate was 38 percent, compared to a three-year survival rate of 51 percent for patients whose surgery was not delayed.

The time from diagnosis to surgery ranged from four days to 175 days, with 26 patients having a delay of more than 93 days, roughly three months. The most common reason for delay was scheduling issues. Less frequent reasons were patients seeking multiple opinions, misdiagnosis or patients reluctant to be treated. Patient indecision was not a common cause of lengthy delays.

"Most of these causes for delaying surgery are potentially reversible, and physicians despite busy schedules and the need for second opinions need to be diligent about coordinating appointments and information in a timely way," says lead study author Cheryl Lee, M.D., director of the bladder cancer program at the U-M Comprehensive Cancer Center and assistant professor of urology at the U-M Medical School.

The researchers believe a delay in treatment could cause micrometastases, cancer cells that spread through the body but in small quantities that cannot be detected by standard imaging techniques. The short survival less than a year among patients whose surgery was delayed more than 93 days is similar to survival for bladder cancer patients in which it is known the cancer has spread.

Some causes of treatment delay were unavoidable and irreversible, such as the patient being too old for surgery or having other medical conditions that rule out surgery.

Cystectomy is standard treatment for bladder cancer that has invaded the nearby muscle. Typically, five-year survival rates after surgery are as high as 80 percent.

This year, an estimated 61,420 Americans will be diagnosed with bladder cancer and 13,000 will die from it, according to the American Cancer Society. The disease affects men three times more often than women.

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For more information about bladder cancer, visit www.cancer.med.umich.edu/learn/bladtum.htm or call the Cancer AnswerLine at 800-865-1125.

In addition to Lee, U-M study authors were Rabii Madii, M.D., clinical lecturer in urology; Stephanie Daignault, biostatistician; Rodney Dunn, statistician expert; Yingxi Zhang, research associate; James Montie, M.D., Valassis Professor of Urologic Oncology and professor and chair of urology; and David Wood Jr., M.D., professor of urology.

Funding for the study was from the Robert and Elizabeth Teeter Bladder Cancer Fund.

Reference: Journal of Urology, Vol. 175, No. 4, pp. 1262-1267.


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