TY - JOUR
T1 - Survival impact of followup care after radical cystectomy for bladder cancer
AU - Strope, Seth A.
AU - Chang, Su Hsin
AU - Chen, Line
AU - Sandhu, Gurdarshan
AU - Piccirillo, Jay F.
AU - Schootman, Mario
N1 - Funding Information:
Supported by Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 from the National Center for Advancing Translational Sciences , American Cancer Society Institutional Review Grant IRG-58-010-53 , Barnes Jewish Hospital Foundation/ICTS Clinical and Translational Science Research award UL1 RR024992, Grant R24 HS19455 through the Agency for Healthcare Research and Quality , and the Washington University KL2 Career Development Awards Program ( KL2 TR000450 ).
PY - 2013/11
Y1 - 2013/11
N2 - Purpose: Due to substantial variation in patient followup after radical cystectomy for bladder cancer, we sought to understand the effect of urine and 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 (SEER)-Medicare data. Using propensity score analysis, we assessed the relationship between time and geography standardized expenditures on followup care and overall survival during 3 postoperative periods, including perioperative (0 to 3 months), early followup (4 to 6 months) and later followup (7 to 24 months). Using instrumental variable analysis, we assessed the overall survival impact of the quantity of followup care by category, including physician visits, imaging, and laboratory and urine tests. Results: We found no improvement in survival due to followup care in the perioperative and early followup periods. Receiving followup care during later followup was associated with improved survival in the low, middle and high expenditure tertiles (HR 0.23, 95% CI 0.15-0.35, HR 0.27, 95% CI 0.18-0.40 and HR 0.47, 95% CI 0.31-0.71, respectively). Instrumental variable analysis suggested that only physician visits and urine testing improved survival (HR 0.96, 0.93-0.99 and 0.95, 0.91-0.99, respectively). Conclusions: Followup care after radical cystectomy in the later followup period was associated with improved survival. Physician visits and urine tests were associated with this improved survival. Our results suggest that aspects of followup care significantly improve patient outcomes but imaging could be done more judiciously after cystectomy.
AB - Purpose: Due to substantial variation in patient followup after radical cystectomy for bladder cancer, we sought to understand the effect of urine and 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 (SEER)-Medicare data. Using propensity score analysis, we assessed the relationship between time and geography standardized expenditures on followup care and overall survival during 3 postoperative periods, including perioperative (0 to 3 months), early followup (4 to 6 months) and later followup (7 to 24 months). Using instrumental variable analysis, we assessed the overall survival impact of the quantity of followup care by category, including physician visits, imaging, and laboratory and urine tests. Results: We found no improvement in survival due to followup care in the perioperative and early followup periods. Receiving followup care during later followup was associated with improved survival in the low, middle and high expenditure tertiles (HR 0.23, 95% CI 0.15-0.35, HR 0.27, 95% CI 0.18-0.40 and HR 0.47, 95% CI 0.31-0.71, respectively). Instrumental variable analysis suggested that only physician visits and urine testing improved survival (HR 0.96, 0.93-0.99 and 0.95, 0.91-0.99, respectively). Conclusions: Followup care after radical cystectomy in the later followup period was associated with improved survival. Physician visits and urine tests were associated with this improved survival. Our results suggest that aspects of followup care significantly improve patient outcomes but imaging could be done more judiciously after cystectomy.
KW - Cystectomy
KW - Medicare
KW - SEER program
KW - Survival analysis
KW - Urinary bladder neoplasms
UR - http://www.scopus.com/inward/record.url?scp=84888638409&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2013.05.051
DO - 10.1016/j.juro.2013.05.051
M3 - Article
C2 - 23727308
AN - SCOPUS:84888638409
SN - 0022-5347
VL - 190
SP - 1698
EP - 1703
JO - Journal of Urology
JF - Journal of Urology
IS - 5
ER -