Trends in the use of radiotherapy and radical surgery for patients with bladder urothelial cell carcinoma in East Anglia, 1995–2006

• Published in: BJU international 2011-10, Vol.108 (7), p.1106-1114
• Main Authors: Barbiere, Josaphine M., Saeb‐Parsy, Kasra, Greenberg, David C., Wright, Karen A., Brown, Clement H., Neal, David E., Lyratzopoulos, Georgios
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; bladder; Bladder cancer; cancer; Carcinoma, Transitional Cell - radiotherapy; Carcinoma, Transitional Cell - surgery; Confidence intervals; Female; Humans; Male; Medical sciences; Middle Aged; Morphology; Nephrology. Urinary tract diseases; Practice Patterns, Physicians' - trends; Radiation therapy; radiotherapy; Retrospective Studies; Studies; Surgery; Time Factors; Trends; Tumors of the urinary system; United Kingdom; Urinary Bladder Neoplasms - radiotherapy; Urinary Bladder Neoplasms - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; urothelial
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.10058.x

Study Type – Prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? 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. 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. OBJECTIVE •  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. PATIENTS AND METHODS •  Population‐based data (1995–2006) from a cancer registry with stable coding practices were analysed. •  Bladder UCC was defined using relevant International Classification of Disease site and morphology codes. •  Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined. RESULTS •  Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%). •  Morphology and stage case mix remained stable during the study period. •  Radiotherapy use decreased significantly (from 31% in 1995–1998 to 22% in 2003–2006, P < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, P < 0.001), particularly among stage II–IV patients. •  The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%). •  Women were significantly more likely to present in stages II–IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06–1.40, P= 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72–0.99, P= 0.036). CONCLUSIONS •  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. •  Further research should encompass treatment timeliness and other aspects of care quality, as well as explor