Causes and Consequences of Delayed Presentation of Muscle Invasive Urinary Bladder Carcinoma.

Abstract

Lag times for the diagnosis and treatment of urinary bladder cancer are generally longer which reduces the chances of achieving cures. This study was carried out at the Urology Department of Bangabandhu Sheikh Mujib Medical University, Dhaka and a Urology Center in a private hospital in Dhaka, Bangladesh from July 2007 to June 2008 on patients of newly diagnosed muscle invasive bladder carcinoma. This study was intended to assess the delay encountered by the patients and its consequences in the process of diagnosis and treatment of bladder cancer. This cross-sectional study was conducted on 50 patients of newly diagnosed muscle invasive bladder carcinoma. The five types of delays studied were: Delay-1 or Patient Delay; Delay-2 or GP (General Practioners) Delay; Delay-3 or First Treatment Delay; Delay-4 or the lag time from TURBT (Trans Urethral Resection of Bladder Tumor) to obtaining the biopsy report and Delay-5 from the biopsy report to final treatment. These five delays were added together to find the total delay. A 6-month period was used as a cut-off point to divide the patients into shorter (≤180 days) and longer (>180 days) delay groups and all the variables of interest were compared between these two groups to find the causes and consequences of delay in bladder cancer. The total median delay encountered by the patients was 220(45-888) days. The median Delay 1 was the shortest (3.5 days), while the median Delay 2 was the longest (91.5 days) among the 5 delays. The median Delay 3, Delay 4 and Delay 5s were 12.5, 12.5 and 11 days respectively. Older and female patients were predominant among the delayed group (86.7% and 40.0% respectively) than those among the non-delayed group (65.0% and 15.0% respectively) (p=0.134 and p=0.059 respectively). One-third of the delayed presenters was housewife as opposed 10.0% of the early presenters (p=0.048). Illiterate and middle and poor income subjects delayed significantly more than their educated and solvent counterparts (p=0.052 and p=0.012 respectively). Delayed group had a 25.0% increase in the incidence of pT3 - 4 (p=0.083) and 23.0% increase in the non-organ confined disease (N stage positive) than the non-delayed group (p=0.103). Distant or lymph node metastasis was relatively higher in delayed group (p=0.279). A delay in the presentation of muscle-invasive bladder tumors may lead to larger lesions and disease dissemination, resulting in advanced disease. GP delay is the longest to contribute to the total delay.