Understanding Avoidance, Refusal, and Abandonment of Chemotherapy Before and After Cystectomy for Bladder Cancer

Rehman, Shabnam; Crane, Alice; Din, Rakeeba; Raza, Syed Johar; Shi, Yi; Wilding, Gregory E.; Levine, Ellis G.; George, Saby; Пили, Роберто; Trump, Donald L.; Guru, Khurshid A.

doi:10.1016/j.urology.2013.07.055

Cited by 32 publications

(12 citation statements)

References 18 publications

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“…Previous studies suggest that referral rates to a medical oncologist are generally low and may account for non-receipt of NC. [11][12][13] Prior studies evaluating NC in MIBC suggest that the implementation of a standardized multidisciplinary approach increases the referral rate and the uptake of NC in eligible patients, even in the academic setting. 11,13 Respondents who saw and referred the highest cases of NC annually reported doing so in the context of a multidisciplinary clinic.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

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Introduction: Uptake of neoadjuvant chemotherapy (NC) for muscle invasive bladder cancer (MIBC) has been low despite evidence of a survival benefit. The primary aim of this study was to better understand why the rates are low and determine what factors specifically influence the decision to recommend NC for MIBC. Methods: A 31-question survey was emailed between 2009 and 2011 to medical oncologists belonging to the Canadian Association of Genitourinary Medical Oncologists (CAGMO); and to urologists belonging to the Canadian Urologic Oncology Group (CUOG). We gathered data on practice characteristics, referrals for NC, factors influencing NC use, and chemotherapy regimens offered. Responses were summarized using descriptive statistics. Results: In total, 26/30 (87%) medical oncologists and 25/84 (30%) urologists, who were primarily academic, completed the survey. Most clinicians (medical oncologists 96%, urologists 88%) recommended NC for MIBC, because they considered it to be the standard of care, but most medical oncologists saw ≤6 referrals annually. Performance status, presence of comorbidities and renal function were key considerations in offering NC. NC was not offered if performance status ≥2 (medical oncologists 38%, urologists 44%), age >80 (medical oncologists 46%, urologists 39%), or glomerular filtration rate ≤40 mL/min (medical oncologists 81%, urologists 50%). Conclusions: Most academic clinicians in Canada believe that cisplatin-based combination NC is the standard of care for MIBC and recommend it for patients with adequate performance status and renal function. Using a multidisciplinary approach to treat this disease may be one strategy to increase referral rates for NC and uptake of NC.

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Section: Discussionmentioning

confidence: 99%

“…Lastly, patient preference for immediate definitive therapy and/or to not receive chemotherapy was not accounted for in our study. 13 …”

Section: Discussionmentioning

confidence: 99%

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

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“…Nonetheless, despite this evidence and current guideline recommendations advocating the use of NAC, wide spread adoption has not occurred [4][5][6][7] . Factors such as patient refusal, need for immediate surgery, medical comorbidities and lack of local access to medical oncology support serve as potential barriers for low utilization rates 8 .…”

Section: Introductionmentioning

confidence: 99%

Trends and disparities in the use of neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma

Duplisea

Mason

Reichard

et al. 2018

CUAJ

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Introduction: Neoadjuvant chemotherapy (NAC) prior to radical or partial cystectomy is considered the standard of care for eligible patients with muscle-invasive urothelial carcinoma. Despite guideline recommendations, adoption of NAC has historically been low, although prior studies have suggested that use is increasing. In this contemporary study, we examine trends in the use of NAC and explore factors associated with its receipt. Methods: We identified patients in the National Cancer Database who underwent radical or partial cystectomy for cT2-cT4N0M0 urothelial carcinoma from 2006-2014. The proportion of patients receiving NAC during each year was examined. Logistic regression models were used to evaluate clinical and socioeconomic factors associated with the receipt of NAC. Results: A total of 18 188 patients were identified who underwent radical or partial cystectomy for muscle-invasive bladder cancer. Overall, 3940 (21.7%) received NAC. We noted a significant increase in the use of NAC over time, from 9.7% in 2006 to 32.2% in 2014. Factors associated with lower use of NAC include older age, higher comorbidity score, lower cT stage, lower hospital radical cystectomy volume, treatment at a non-academic facility, lower patient income, and receipt of partial cystectomy (all p<0.001). Interestingly, neither sex nor race were associated with receipt of NAC. Conclusions: Use of NAC has increased significantly over time to a modest rate of 32%. However, disparities still exist in the receipt of NAC and future efforts aimed at mitigating these disparities are warranted.

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“…In one study, 7-22 % of cancer patients were judged to be good candidates for chemotherapy, were actively counseled about their disease, and were recommended for chemotherapy, yet refused it [12]. Patients refuse their physician's recommendation much more rarely regarding surgical and radiotherapy treatments for cancer (0.4 and 0.9 %, respectively), although a positive correlation does exist with increasing age [13,14]. Clearly the morbidity associated with chemotherapy carries with it a special stigma.…”

Section: Discussionmentioning

confidence: 99%

Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma

et al. 2015

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Understanding Avoidance, Refusal, and Abandonment of Chemotherapy Before and After Cystectomy for Bladder Cancer

Cited by 32 publications

References 18 publications

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Trends and disparities in the use of neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma

Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma

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