Trends in the use of radiotherapy and radical surgery for patients with bladder urothelial cell carcinoma in East Anglia, 1995-2006

Objective To examine the use of radiotherapy and radical surgery for bladder urothelial cell carcinoma (UCC) before, during and after national initiatives for reorganization of uro-oncology services. Patients and Methods Population-based data (1995-2006) from a cancer registry with stable coding practices were analysed. Bladder UCC was defined using relevant International Classification of Disease site and morphology codes. Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined. Results Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%). Morphology and stage case mix remained stable during the study period. Radiotherapy use decreased significantly (from 31% in 1995-1998 to 22% in 2003-2006, P < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, P < 0.001), particularly among stage II-IV patients. The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%). Women were significantly more likely to present in stages II-IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06-1.40, P= 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72-0.99, P= 0.036). Conclusions Use of radical surgery in UCC invading bladder muscle increased and use of radiotherapy decreased during the study period, most probably reflecting the increasing availability of specialist surgical management. Sociodemographic variation in treatment was limited to lower use of radiotherapy in women. Further research should encompass treatment timeliness and other aspects of care quality, as well as exploring potential differences in endoscopic treatments for disease not invading bladder muscle.