Evidence map›Paper›PMID 26977202›Full record

ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada

The initiation of a multidisciplinary bladder cancer clinic and the uptake of neoadjuvant chemotherapy: A time-series analysis.

Madhur Nayan, Bimal Bhindi, Julie L Yu, Muhammad Mamdani, Neil E Fleshner, Thomas Hermanns, Peter Chung, Michael Milosevic, Robert Bristow, Padraig Warde and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

  1. Article
  2. 2025 Canadian Urological Association Expert Report: Muscle-invasive bladder cancer.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2025
    Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Canadian Urological Association guideline: Muscle-invasive bladder cancer.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2019
    Article
  8. Article
  9. Perioperative chemotherapy for bladder cancer: A qualitative study of physician knowledge, attitudes, and behaviour.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2018
    Article
  10. Review
  11. Treatment of bladder cancer in the elderly.Investigative and clinical urology · 2016
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Madhur NayanDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Bimal BhindiDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Julie L YuDepartment of Anesthesia, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada;
Muhammad MamdaniLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada;
Neil E FleshnerDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Thomas HermannsDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Peter ChungDepartment of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;
Michael MilosevicDepartment of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;
Robert BristowDepartment of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;
Padraig WardeDepartment of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;
Robert J HamiltonDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Antonio FinelliDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Michael A S JewettDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Alexandre R ZlottaDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;; Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada;
Srikala S SridharDivision of Medical Oncology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada;
Girish S KulkarniDivision of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWhile level 1 evidence supports the use of neoadjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer (MIBC), its uptake has been underwhelming, even in academic centres. Our aim was to determine if the initiation of a multidisciplinary bladder cancer clinic (MDBCC) in 2008 at our institution, where patients are assessed simultaneously by bladder cancer-focused urologists and radiation oncologists with easy access to a medical oncologist, was associated with an increased use of NAC.

methodsPatients with MIBC initiating treatment between July 2000 and June 2013 were identified and classified by academic year (July 1 to June 30). Time-series analyses using interventional autoregressive integrated moving average (ARIMA) models with ramp intervention functions were then conducted. A sensitivity analysis was performed on clinical N0 patients.

resultsThe cohort included 278 patients: 168 from 2000-2007 and 110 from 2008-2012 (academic years). Forty-two (15.1%) patients received NAC and 74 (26.6%) received adjuvant chemotherapy (AC). Overall the proportion of patients receiving NAC increased from 7.7% before the MDBCC to 47.6% in 2012 (Interventional ARIMA p=0.036). The results were similar when restricting to cN0 patients (p<0.001). NAC use gradually increased over time regardless of MDBCC attendance, although the proportion of patients receiving NAC appears to have risen more sharply among MDBCC attendees.

conclusionsAt our institution, the initiation of the MDBCC was temporally associated with increased use of NAC. In addition to multidisciplinary collaboration, having a critical mass of NAC physician advocates and support from institutional leaders are essential to the uptake of NAC.

Identifiers

PMID26977202
PMCPMC4771554

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.