Survival Impact of Follow-up Care after Radical Cystectomy for Bladder Cancer
Strope SA, Chang SH, Chen L, Sandhu G, Piccirillo JF, Schootman M. J Urol. 2013 May 29. pii: S0022-5347(13)04416-9. doi: 10.1016/j.juro.2013.05.051. [Epub ahead of print]

Source

Division of Urology, Department of Surgery, Washington University. Electronic address: stropes@wudosis.wustl.edu.

Abstract

PURPOSE:

With substantial variation in follow-up for patients after radical cystectomy for bladder cancer, we sought to understand the effect of urine tests, laboratory tests, physician visits, and imaging on overall survival.

MATERIALS AND METHODS:

We analyzed a cohort of patients treated in the fee-for-service Medicare population from 1992 through 2007 using Surveillance Epidemiology and End Results - Medicare data. Using propensity score analysis, we assessed the relationship between time- and geography-standardized expenditures on follow-up care and overall survival in three time periods after surgery: peri-operative (0-3 months), early follow-up (4-6 months), and later follow-up (7-24 months). Using instrumental variables analysis, we assessed the overall survival impact of quantity of follow up care by category (doctor visits, imaging, lab tests, urine tests).

RESULTS:

We found no improvement in survival from follow-up care in the peri-operative and early follow-up periods. Receipt of follow-up care in the later follow-up period was associated with improved survival [HR 0.23, 95% CI 0.15-0.35; 0.27, 95% CI: 0.18-0.40; 0.47, 95% CI: 0.31-0.71, low, middle and high tertile of expenditures, respectively]. Instrumental variables analysis suggested only doctor visits and urine testing [HRs: 0.96 (0.93-0.99) and 0.95 (0.91-0.99), respectively] improved survival.

CONCLUSION:

Follow-up care after radical cystectomy in the later follow-up period was associated with improved survival. Doctor visits and urine tests were associated with this improved survival. Our results suggest aspects of follow-up care significantly improve patient outcomes, but imaging studies could be used more judiciously after cystectomy.