Cystectomy for muscle-invasive bladder cancer: Patterns and outcomes of care in the medicare population Journal Article


Authors: Schrag, D.; Mitra, N.; Xu, F.; Rabbani, F.; Bach, P. B.; Herr, H.; Begg, C. B.
Article Title: Cystectomy for muscle-invasive bladder cancer: Patterns and outcomes of care in the medicare population
Abstract: Objectives. To describe the population-based patterns of care among patients with muscle-invasive bladder cancer. Methods. A retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER)-Medicare database identified 4664 patients aged 65 years or older with muscle-invasive bladder cancer diagnosed between 1991 and 1999. The use of particular treatment modalities was evaluated according to the clinical and demographic characteristics available in the SEER-Medicare database. Results. Considerable variation was found in the treatments delivered to the cohort members. Overall, 39% had undergone cystectomy; 30% of Stage II, 57% of Stage III, and 38% of Stage IV patients underwent this operation within 6 months of diagnosis. The frequency of resection declined with age, such that 55% of patients aged 65 to 69 years and 27% of those aged 80 to 84 years underwent cystectomy. For 36% of Stage II, 18% of Stage III, and 27% of Stage IV patients, no evidence was found of surgery, chemotherapy, or radiotherapy within 6 months of diagnosis. Other management strategies included chemotherapy alone (14% Stage II, 6% Stage III, and 12% Stage IV), radiotherapy alone (11% for each stage), or combined modality chemoradiotherapy (10% Stage II, 8% Stage III, and 12% Stage IV). Multivariate analyses suggested that cystectomy conferred a survival advantage. Conclusions. A marked heterogeneity exists in the strategies used to treat muscle-invasive bladder cancer. The extent to which this variation can be attributed to the lack of informative clinical trials, the presence of comorbid illness, patient or physician preferences, or access to care warrants further evaluation. © 2005 Elsevier Inc.
Keywords: cancer chemotherapy; cancer survival; controlled study; aged; aged, 80 and over; middle aged; survival rate; major clinical study; cancer radiotherapy; cancer staging; cancer diagnosis; physician's practice patterns; demography; cohort analysis; data base; retrospective study; urinary bladder neoplasms; cancer invasion; medicare; disease severity; cystectomy; multivariate analysis; bladder carcinoma; bladder muscle
Journal Title: Urology
Volume: 65
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2005-06-01
Start Page: 1118
End Page: 1125
Language: English
DOI: 10.1016/j.urology.2004.12.029
PUBMED: 15922428
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 25" - "Export Date: 24 October 2012" - "CODEN: URGYA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Nandita Mitra
    22 Mitra
  2. Feng Xu
    5 Xu
  3. Colin B Begg
    241 Begg
  4. Farhang Rabbani
    82 Rabbani
  5. Deborah Schrag
    137 Schrag
  6. Peter Bach
    204 Bach
  7. Harry W Herr
    411 Herr