Mortality Increases When Radical Cystectomy is Delayed More Than 12 Weeks

Results from a Surveillance, Epidemiology, and End Results - Medicare Analysis

When surgery is delayed more than 12 weeks after diagnosis for muscle-invasive bladder cancer, mortality rates increase as the delay lengthens, according to this survey of cancer registry and Medicare data. Surgery is delayed for many reasons, but the authors question the wisdom of “urbanization” of the procedure: surgery is often delayed when patients are transferred to high-volume, urban academic facilities, which are better able to provide the extensive care required, but receive lower reimbursements for the care.

Cystectomy for muscle-invasive bladder cancer is a difficult, life-changing procedure with many potential complications often related to a patient’s generally poor health. Delays in providing surgery arise for many reasons. This study sought to examine patient outcomes versus timing of surgery using data from the Surveillance, Epidemiology, and End Results (SEER) national cancer registry and the Medicare claims database. In the survey sample, there were 441 patientsmostly male, white and marriedwho were treated with cystectomy for this stage bladder cancer between 1992 and 2001.

Key Findings:

  • Although time from diagnosis to surgery ranged from four to 52 weeks, 89 percent underwent surgery within 24 weeks of diagnosis and 73 percent of those underwent surgery within 12 weeks.
  • During the study period, 279 subjects died, most often from bladder cancer or cardiovascular disease.
  • Mortality rates were relatively stable when surgery was performed from 4-12 weeks, but patients whose surgery was performed from 12-24 weeks were twice as likely to die as those who had surgery within 4-8 weeks.
  • The longer surgery was delayed beyond 12 weeks, the greater the patient’s risk of dying whether or not death was caused by bladder cancer.

This surgical procedure is often delayed for patient-specific reasons, but the authors note delays commonly arise because of patient transfers to centralized high-volume centers that are better able to provide the extensive hospitalization and care required, despite poor reimbursement for the procedure and postoperative care. Although these centers may have better immediate surgical outcomes, this study suggests that, if patient transfers result in delays of treatment, the long-term survival of patients may be compromised. The authors urge all efforts be made to expedite surgery of these patients within 12 weeks.