Although the use of perioperative chemotherapy (POC) and neoadjuvant chemotherapy (NAC) in patients with bladder cancer has risen in Quebec, these rates are lower than those reported in most developed countries, a recent study has shown (Can Urol Assoc J. 2019 Nov 29. Epub ahead of print).

Although benefits of POC have been shown, there are studies that describe poor use of the procedure in patients with bladder cancer undergoing radical cystectomy, explained lead investigator Michel D. Wissing, MD, PhD, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada, and colleagues, who conducted a study assessing the use of POC in Quebec.

Dr Wissing et al retrospectively collected data from provincial health administrative databases for patients undergoing radical cystectomy from 2 years before the procedure until December 2016 or death. Variables predicting the use of POC were identified through the use of logistic regression, and Cox regression was used to carry out survival analyses.

Between January 2000 and September 2016, and of 4656 patients in Quebec, 790 (17.0%) were given POC, which was observed to be more frequently utilized in patients who had recently undergone surgery, were younger in age, had fewer comorbidities, lived closer to the hospital of surgery, and a high surgeon's radical cystectomy volume (P <.05).

Findings also showed an increase in NAC use in recent years, from 3.5% in 2009 to 11.2% in 2012 and 20.7% in 2015.

Among patients who received treatment between 2013 and 2016, a younger age (odds ratio [OR], 0.71; 95% CI, 0.64-0.80 per 5 years), shorter distance to the hospital (OR, 0.88; 95% CI 0.77-0.99 per 50 km), surgery in an academic hospital (OR, 1.86; 95% CI 1.06-3.29), and recent surgery (OR, 1.34; 95% CI, 1.14-1.58 annually) were factors independently shown to predict NAC use. Of note, these patients who received NAC had significantly higher OS rates than patients without POC (hazard ratio, 0.73; 95% CI, 0.55-0.97).

“NAC/POC use increased in Quebec but was lower compared to most developed countries. Its use was lower in patients residing further from the hospital and in those treated in non-academic hospitals,” Dr Wissing and colleagues concluded.—Hina Porcelli