Effectiveness of chemotherapy administration and time to cystectomy following neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) in the academic and community settings.

Abstract

359 Background: Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy is the standard of care for MIBC. Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. It is unknown if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC. Methods: This is a retrospective study of 135 patients referred to a single AMC with MIBC (cT2a-T4-Nx-M0) between 1/2012 and 1/2014. We analyzed patient demographics, clinical stage, treatment, pT0 and time to cystectomy in patients who received NAC at our AMC compared to those referred to the community setting. Comparisons were made using Wilcoxon rank-sum, Fisher’s exact test, and multivariable linear regression. Results: Median age was 70, 73% were male, and 83% Caucasian. Most patients (73.3%) had clinical stage II disease. 94 (69.6%) underwent cystectomy and of those, 47 (50%) received NAC. 34% received NAC at our AMC and 66% in the community. Age, sex, clinical stage, and renal function did not differ significantly between those who received NAC in the community and those at our AMC. Those who received NAC in the community had a similar total dose of cisplatin (median 280 mg/m2 for both groups, p=0.89) and pT0 rate (25% vs. 30%, p=0.72) compared to those who received NAC at our AMC. However, community administration of NAC was associated with a significantly prolonged time from initial visit to cystectomy (median number of days 128 vs. 162, p<0.01). This remained significant after adjusting for age and renal function (p=0.04). Conclusions: Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates suggesting the effective implementation of NAC in the community setting. However, those who received NAC in the community had a significantly longer time from initial visit to cystectomy, suggesting a delay in the transfer of care between settings and an area for improvement.