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Delay in surgery decreases survival for bladder cancer patients

ANN ARBOR, Mich. -- Bladder cancer patients whose surgery was delayed for more than three months after their diagnosis were more likely to die from their disease than patients whose surgery was performed sooner, according to a study by researchers at the University of Michigan Comprehensive Cancer Center.

The study, published in the April Journal of Urology, looked at 214 patients diagnosed with muscle-invasive bladder cancer and treated with radical cystectomy, an operation in which the bladder is removed. The researchers found that patients whose surgery was delayed more than 93 days from the date of diagnosis had worse survival rates compared to patients whose surgery occurred in fewer than 93 days.

Thirty-nine percent of patients without a delay died, while 54 percent of patients with a delay died. The patients whose surgery was delayed lived on average only one year, and their three-year survival rate was 38 percent, compared to a three-year survival rate of 51 percent for patients whose surgery was not delayed.

The time from diagnosis to surgery ranged from four days to 175 days, with 26 patients having a delay of more than 93 days, roughly three months. The most common reason for delay was scheduling issues. Less frequent reasons were patients seeking multiple opinions, misdiagnosis or patients reluctant to be treated. Patient indecision was not a common cause of lengthy delays.

"Most of these causes for delaying surgery are potentially reversible, and physicians despite busy schedules and the need for second opinions need to be diligent about coordinating appointments and information in a timely way," says lead study author Cheryl Lee, M.D., director of the bladder cancer program at the U-M Comprehensive Cancer Center and assistant professor of urology at the U-M Medical School.

The researchers believe a delay in treatment could cause micrometastases, cancer cells that spread through the body but in small quantities
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