[State of practice: Quebec portrait of bladder cancer incidence, radical cystectomy practice, and resulting clinical outcomes]
Dufour V, Provost V
Record ID 32018013193
French
Original Title:
Portrait québécois de l’incidence du cancer de la vessie, de la pratique des cystectomies radicales et des résultats cliniques en découlant
Authors' objectives:
Bladder cancer affects males more than females. It is the fourth most frequently
diagnosed cancer in men, and the ninth in women, in Canada. It also represents the ninth
leading cause of cancer death across both sexes.
Radical cystectomy is an effective curative treatment for certain bladder cancers. This
complex and consequential surgery involves the complete removal of the bladder
combined 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 aimed at
enhancing the quality of care and services surrounding the practice of radical
cystectomies.
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 aimed at ensuring 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 regarding clinical and organizational modalities that
promote the quality of care and services for individuals 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), a portrait of
Quebec practice related to bladder cancer and radical cystectomy (État des pratiques,
this document), as well as 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.
• In Quebec, the median overall survival of people who underwent surgery for
bladder cancer between 2010 and 2019 was 4.5 years (95% CI 4.1-5.0 years).
Among these, 3% died during hospitalization and 6% died within 90 days of
surgery (compared to a rate ranging from 1.9% to 4.7% and 2.9% to 8.8%,
respectively, according to the scientific literature).
(#2 THE PRACTICE OF RADICAL CYSTECTOMY HAS BEEN PARTIALLY CENTRALIZED IN QUEBEC SINCE 2009): In Quebec, approximately 70% of urologists who perform radical cystectomy have
had an annual volume per surgeon of fewer than seven surgeries per year.
However, since 2009, the proportion of patients operated on by urologists who
had performed seven or more radical cystectomies per year has surpassed that of
patients operated on by urologists who had performed fewer than seven per year. (#3 A HIGHER VOLUME OF CYSTECTOMIES COULD CONTRIBUTE TO AN IMPROVEMENT IN CERTAIN CLINICAL
OUTCOMES IN QUEBEC): In these same analyses, health outcomes after radical cystectomy are associated,
to varying degrees, with the level of service of hospitals, their surgical volume,
and urologists’ surgical volume.
• Overall survival appears to be better when the surgical volume per hospital and
per urologist increases. The increase in surgical volume per hospital is possibly
associated with more hospitalizations of 10 days or less, while the increase in
surgical volume per urologist appears to be associated with fewer deaths at
30 and 90 days. CONCLUSION: This document has provided a portrait of the clientele and services offered in Quebec
from 2003 to 2022. Furthermore, multivariate analyses were conducted concerning the
clinical outcomes of individuals with bladder cancer after undergoing radical cystectomy,
based on certain exposure variables by hospital and surgeon.
The portrait highlighted a partial concentration of radical cystectomy practices starting
from 2009. Most people underwent surgery in the regions of Montréal and CapitaleNationale, largely in quaternary-level referral centres for genitourinary oncology. Since
2015, the majority of people have underwent surgery in four hospitals that performed
25 or more radical cystectomies per year and, to a lesser extent, in 8 to 13 hospitals, depending on the year, distributed elsewhere in the province. Some hospitals with an
annual surgical volume of fewer than five surgeries per year have ceased to offer the
procedure over time.
Authors' methods:
Clinical-administrative data were used to provide a portrait of the clientele and services
offered in Quebec. This portrait presents notably the incidence of bladder cancer, the
number of patients treated by radical cystectomy, their distribution across Quebec
territory, and the centres where they were operated on. Additionally, analyses were
conducted concerning the clinical outcomes of individuals with bladder cancer after
undergoing radical cystectomy, based on certain exposure variables by hospital and
surgeon. Findings were formulated considering contextual data from the Quebec portrait as well as
identified methodological limitations or biases. The formulation of the findings was
discussed with the advisory committee and then validated by members of the Comité
d’évaluation des pratiques en oncologie (CEPO).
Details
Project Status:
Completed
Year Published:
2024
URL for published report:
https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Oncologie/INESSS_Cystectomie_EP.pdf
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
Province:
Quebec
MeSH Terms
- Urinary Bladder Neoplasms
- Cystectomy
- Delivery of Health Care
- Quality of Health Care
Contact
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)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.