Booth CM, et al. - In this work, contemporary use of neoadjuvant (NACT) and adjuvant chemotherapy (ACT), as well as medical oncology (MO) referral patterns in routine practice, were described. A substantial increase in the use of NACT was evident in the general population after many years of practice lagging behind evidence. Greater preoperative referral to MO as well as the greater propensity of MOs to treat referred patients was identified as the drivers of the increased uptake.

Methods

• Researchers identified all muscle-invasive bladder cancer (MIBC) patients treated with cystectomy in Ontario from 1994 to 2013 by linking electronic treatment records to the population-based Ontario Cancer Registry.
• They used physician billing records to identify consultation with MO.
• A comparison of practice patterns in the contemporary era (2009–2013) with data from 1994 to 2008 was performed.

Results

• For MIBC, 5,582 patients underwent cystectomy.
• An increase in the use of NACT was observed, from 4% in 1994 to 2008 to 19% in 2009 to 2013 (P < 0.001); a continued increase in the rates was noticed in the most recent era, from 12% in 2009 to 27% in 2013 (P < 0.001).
• In 2009 to 2013, ACT was delivered to 20% of patients (19% in 1994–2008, P=0.875).
• In 2009 to 2013, use of any chemotherapy (NACT or ACT) was 35% compared to 23% in 1994 to 2008 (P < 0.001).
• During 2009 to 2013 compared to 1994 to 2008, preoperative referral rates to MO were greater (32% vs 11%, P<0.001); in recent years, a continued increase in referral rates was observed, from 21% in 2009 to 44% in 2013 (P < 0.001).
• A substantial increase in the proportion of referred patients ultimately treated with NACT was evident; from 32% in 1994 to 1998 to 54% in 2009 to 2013 (P < 0.001).