Original Title: Modalités optimales d'organisation et de prestation des soins et services liés à la cystectomie radicale au Québec

Authors' objectives: Bladder cancer is more common in men than in women. It is the fourth most common cancer in men and the ninth most common cancer in women in Canada. It is also the ninth leading cause of cancer deaths, all sexes combined. Radical cystectomy is an effective curative treatment for certain bladder cancers. This complex and consequential surgery involves the complete removal of the bladder along with pelvic lymph node dissection, followed by urinary reconstruction in a second stage. Due to the high risks of postoperative complications and mortality associated with this procedure, some countries have implemented measures to improve the quality of care and services surrounding the practice of radical cystectomy. A urological oncology committee was established by the Programme québécois de cancérologie (PQC) of the Ministère de la Santé et des Services Sociaux (MSSS) to identify strategies to ensure the quality and accessibility of care and services in urology, including radical cystectomy. In support of this committee, the present work aims to formulate recommendations on the clinical and organizational modalities that promote the quality of care and services for people who must undergo radical cystectomy for the treatment of resectable bladder cancer (Avis). The work, divided into three knowledge products, is based on a review of the main scientific data and guidelines on the subject (État des connaissances, this document), on a portrait of Quebec practice in relation to bladder cancer and radical cystectomy (État des pratiques), as well as on consultations with various Quebec stakeholders (Avis).

Authors' results and conclusions: RESULTS (#1 RADICAL CYSTECTOMY FOR THE TREATMENT OF BLADDER CANCER IS PART OF A TRAJECTORY THAT REQUIRES HIGH-QUALITY SPECIALIZED CARE AND SERVICES) : Radical cystectomy is a complex surgery that carries a significant risk of postoperative complications and mortality. (#2 A HIGHER NUMBER OF RADICAL CYSTECTOMIES PERFORMED AT A HOSPITAL COULD BE ASSOCIATED WITH CERTAIN CLINICAL BENEFITS): According to a group of Canadian organizations, hospitals performing fewer than five radical cystectomies per year should stop offering the procedure. • The data are too limited or heterogeneous to determine the relationship between the number of radical cystectomies per hospital and other health outcomes (death within 60 days of surgery, surgical complications, cancer-specific survival, surgical margin status, prevalence of pelvic lymphadenectomy during surgery and lymph node yield after dissection, blood transfusions). (#3 THE CENTRALIZATION OF RADICAL CYSTECTOMY PRACTICE IN OTHER JURISDICTIONS MAY HAVE CONTRIBUTED TO AN IMPROVEMENT IN RESULTS): Despite the numerous shortcomings identified, the centralization experiences reported in the United Kingdom and the Netherlands have shown that the practice of radical cystectomies became more concentrated following the establishment of surgical volume standards by health authorities. (#4 THE MAIN GUIDELINES AND REGULATIONS IDENTIFIED TO IMPROVE THE QUALITY OF CARE AND SERVICES GO BEYOND INCREASING SURGICAL VOLUMES): Most of the guidelines and regulations identified recommend the centralization of cystectomy. The minimum expected surgical volume per hospital or per surgeon varies according to the source consulted (minimum threshold per hospital ranging from 10 to 30 procedures per year; minimum threshold per surgeon ranging from 6 to 15 procedures per year). CONCLUSION: This literature review has identified the existing evidence on the health outcomes of people who have undergone radical cystectomy for the treatment of resectable bladder cancer, as well as the literature related to the clinical and organizational modalities that promote the quality of care and services surrounding this procedure. The listed scientific studies seem to indicate that a higher number of radical cystectomies performed at a single hospital could be associated with certain clinical benefits, including an improvement in overall patient survival. However, the available data is too limited and heterogeneous to make a definitive statement about the relationship between the number of radical cystectomies and other exposure variables, for all the health outcomes evaluated. The main guidelines and regulations identified to improve the quality of care and services go beyond increasing surgical volumes and emphasize the importance of maintaining the clinical and technical expertise of providers. They also stress the need for coordinated and multidisciplinary bladder cancer assessment and management modalities, including the composition and qualifications of care teams. As part of this work, divided into three knowledge products, a portrait of Quebec practice in relation to bladder cancer and radical cystectomy was produced (État des pratiques). Recommendations were also formulated regarding the clinical and organizational modalities that promote the quality of care and services for people who must undergo radical cystectomy for the treatment of resectable bladder cancer (Avis).

Authors' methods: A scoping review was conducted to identify the existing evidence regarding the clinical outcomes of people who have undergone radical cystectomy for the treatment of resectable bladder cancer. National and international guidelines, clinical practice guidelines or guideline reviews, and published national regulatory documents addressing the clinical and organizational modalities that can promote quality of care and services on the subject were also consulted. The selection of documents was made according to inclusion and exclusion criteria predefined by two reviewers. The data extracted by one reviewer, then validated by a second, were analyzed and presented in the form of a narrative synthesis and results tables. Findings were formulated based on existing scientific data regarding the clinical outcomes of people who have undergone radical cystectomy for the treatment of resectable bladder cancer, as well as clinical and organizational modalities that can promote quality of care and services published in clinical guidelines and regulatory documents. The formulation of the findings was discussed with the advisory committee and then validated by the members of the Oncology Practice Review Committee (Comité d’évaluation des pratiques en oncologie, CEPO).

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/modalites-optimales-dorganisation-et-de-prestation-des-soins-et-services-lies-a-la-cystectomie-radicale-au-quebec.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Oncologie/INESSS_Cystectomie_EC.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)