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. 2015 Feb;22(1):e20-6.
doi: 10.3747/co.22.2052.

Urologist referral delay and its impact on survival after radical cystectomy for bladder cancer

F Santos  1 , A Dragomir  2 , W Kassouf  2 , E Franco  1 , A Aprikian  2
Affiliations

Urologist referral delay and its impact on survival after radical cystectomy for bladder cancer

F Santos et al. Curr Oncol. 2015 Feb.

Abstract

Background: Evidence shows that wait times before bladder cancer surgery have been increasing, and wait time can negatively affect survival. We aimed to determine if a long delay caused by an indirect referral before a first urologist visit affects the survival of patients undergoing radical cystectomy for bladder cancer.

Methods: We analyzed data from 1271 patients who underwent surgery for bladder cancer during the decade 2000-2009. The cohort was obtained by linking two administrative databases in the province of Quebec. Patients were considered to have been directly referred to a urologist if they had 5 or fewer visits with a general practitioner before their first urologist visit; otherwise, they were considered to have been indirectly referred. The effect on survival after surgery of a longer delay before a first urologist visit was assessed using Cox regression models.

Results: Median referral delay for the study population was 30 days (56 days for women, 23 days for men; p < 0.0001). Indirect referral was observed for 49% of women and 33% of men. Compared with patients who were directly referred, those who were indirectly referred after first symptoms of bladder cancer experienced poorer survival (hazard ratio: 1.29; 95% confidence interval: 1.10 to 1.52). Women who were indirectly referred had a significant 47% greater risk of death after radical cystectomy. Men who were indirectly referred also experienced decreased survival (adjusted hazard ratio: 1.25; 95% confidence interval: 1.03 to 1.51).

Conclusions: Patients indirectly referred to a urologist had an increased risk of mortality after surgery. Compared with men, women had longer wait times and poorer survival.

Keywords: Urologist referral delay; bladder cancer; cohort study; radical cystectomy; survival.

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Figures

FIGURE 1
FIGURE 1
Selection of the study population. ramq = Régie de l’assurance maladie du Québec; isq = Institut de la statistique du Québec.
FIGURE 2
FIGURE 2
Survival curves for patients who were indirectly or directly referred to a urologist after a first general practitioner visit.
See this image and copyright information in PMC

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