Description:
<jats:sec><jats:label /><jats:p>Study Type – Prevalence (retrospective cohort)</jats:p><jats:p>Level of Evidence 2b</jats:p><jats:p><jats:bold>What’s known on the subject? and What does the study add?</jats:bold></jats:p><jats:p>In the UK, specialist services for the management of urological cancers have been reconfigured substantially in recent time periods. Socioeconomic inequalities in relative survival from bladder cancer have also been documented.</jats:p><jats:p>In part of an English region, use of radical surgery to manage the most common type of bladder cancer increased and use of radiotherapy decreased during 1995–2006, most probably reflecting increasing availability of specialist surgical management. There was no evidence for differences in the use of radiotherapy or radical surgery between patients of different socio‐economic groups.</jats:p></jats:sec><jats:sec><jats:title>OBJECTIVE</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>To examine the use of radiotherapy and radical surgery for bladder urothelial cell carcinoma (UCC) before, during and after national initiatives for reorganization of uro‐oncology services.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>Population‐based data (1995–2006) from a cancer registry with stable coding practices were analysed.</jats:p></jats:list-item>
<jats:list-item><jats:p>Bladder UCC was defined using relevant International Classification of Disease site and morphology codes.</jats:p></jats:list-item>
<jats:list-item><jats:p>Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%).</jats:p></jats:list-item>
<jats:list-item><jats:p>Morphology and stage case mix remained stable during the study period.</jats:p></jats:list-item>
<jats:list-item><jats:p>Radiotherapy use decreased significantly (from 31% in 1995–1998 to 22% in 2003–2006, <jats:italic>P</jats:italic> < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, <jats:italic> P</jats:italic> < 0.001), particularly among stage II–IV patients.</jats:p></jats:list-item>
<jats:list-item><jats:p>The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%).</jats:p></jats:list-item>
<jats:list-item><jats:p>Women were significantly more likely to present in stages II–IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06–1.40, <jats:italic>P</jats:italic>= 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72–0.99, <jats:italic>P</jats:italic>= 0.036).</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>Use of radical surgery in UCC invading bladder muscle increased and use of radiotherapy decreased during the study period, most probably reflecting the increasing availability of specialist surgical management. Sociodemographic variation in treatment was limited to lower use of radiotherapy in women.</jats:p></jats:list-item>
<jats:list-item><jats:p>Further research should encompass treatment timeliness and other aspects of care quality, as well as exploring potential differences in endoscopic treatments for disease not invading bladder muscle.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec>