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Identifying Institutional Causes of Delay to Radical Cystectomy among Patients with High Risk Bladder Cancer Treated
Nima Almassi1, Katherine E Glass2, Jennifer L Lonzer2
1Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Urology Practice
|June 14, 2023
Summary
Delays in bladder cancer treatment, including referral and scheduling, impact survival. Institutional factors like awaiting clearance and staging studies contribute to these delays, affecting radical cystectomy timelines.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Treatment delay in muscle-invasive bladder cancer is linked to reduced survival rates.
- Limited research exists on institutional factors causing treatment delays for bladder cancer patients.
Purpose of the Study:
- To identify institutional causes of treatment delay for radical cystectomy in high-risk bladder cancer patients.
- To characterize the patient pathway to cystectomy and quantify time intervals.
Main Methods:
- Retrospective review of 176 bladder cancer patients undergoing radical cystectomy.
- Process mapping to define and quantify time intervals for each step in the treatment pathway.
- Identification and examination of causes for treatment delays exceeding 90 days.
Main Results:
- 13.6% of patients (24/176) experienced treatment delay.
- Key delays occurred in referral, preoperative medical clearance, staging studies, and surgical scheduling.
- Median times to cystectomy varied significantly based on treatment pathway (e.g., 28 days direct vs. 41-44 days post-chemotherapy/resection).
Conclusions:
- Multiple institutional factors contribute to treatment delays for bladder cancer patients.
- Process mapping is an effective tool for analyzing complex treatment pathways and identifying delay points.
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