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]


Division of Urology, Department of Surgery, Washington University. Electronic address:



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.


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).


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.


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.