Care Coordination Faces Neoadjuvant Chemotherapy Delays in MIBC

More than one-third of patients with muscle-invasive bladder cancer (MIBC) waited longer than 60 days from pathologic diagnosis to start neoadjuvant chemotherapy at a large academic cancer center, and most delays stemmed from potentially modifiable care-coordination factors, according to a retrospective study presented at the 2026 ASCO Quality Care Symposium.¹

Why does time to neoadjuvant chemotherapy matter?

Delays of more than 60 days from MIBC diagnosis to neoadjuvant chemotherapy can negatively affect cancer-related outcomes, yet the underlying causes have been poorly characterized, the investigators wrote.¹ The question is growing in importance as 2026 guideline updates move newer agents into the neoadjuvant setting for MIBC.²

How was the study designed?

Investigators led by Margaux Wooster at Columbia University Irving Medical Center identified patients with MIBC treated with neoadjuvant chemotherapy before surgery between 2014 and 2024 through the electronic health record, then used chart review to determine reasons for delay. The primary outcome was delay of more than 60 days from pathologic diagnosis to first systemic chemotherapy; the secondary outcome was the number of days to treatment initiation. Covariates included sex, race, preferred language and disease stage.¹

What did the researchers find?

The analysis included 117 patients, of whom 78.6% were male, 84.6% were White and 88.0% were non-Hispanic. Median time from pathologic diagnosis to neoadjuvant chemotherapy was 47 days (IQR, 33-65), and 41 patients (35%) experienced a delay of more than 60 days.¹ Among those 41 patients, reasons for delay were:

• Additional imaging or procedure: 29.2%
• Second opinion or transfer of care: 22.0%
• Comorbidity management: 19.5%
• Psychosocial factors: 7.3%
• Clinical trial enrollment: 4.9%
• Unknown: 17.1%

No covariates significantly predicted whether a delay occurred in univariate or multivariable analyses. In a multivariable analysis of time to treatment initiation, the authors reported that Black race was associated with a higher likelihood of delay compared with White race, although the association was not statistically significant (HR, 1.92; 95% CI, 0.92-4.00; P = .082). Sex, preferred language and clinical stage were not significantly associated with time to treatment.¹

What do the findings reveal about care coordination?

Coauthor Melissa P. Beauchemin, PhD, RN, CPNP, CPON, FAAN, assistant professor of nursing at Columbia University School of Nursing and scientific lead for cancer care delivery research with the CUIMC Minority/Underserved NCI Community Oncology Research Program at Herbert Irving Comprehensive Cancer Center, said the results show that some delays are expected and others are not.

"What it highlights is some of those delays are expected," Beauchemin said in an interview with Oncology Nursing News. "If you have a complicated cancer and you're going for a second opinion, that's going to lead to a delay. And it may be the right choice, but also some of these delays may be preventable, and there may be ways that we can improve our care delivery system."

She said opportunities extend beyond scheduling to "helping patients know: Where do they go next? What is the next step?" That can include a simple outline of the diagnosis, the plan and the support available, as well as candor about limits.

"People need to know what they aren't going to be helped with, because unfortunately, our healthcare system doesn't have the bandwidth to navigate every single person step by step," she said. Instead, clinicians can help patients anticipate when they will need to "pull in a family member or a friend or an aunt to help you get to this other appointment that's going to be necessary."

"We've looked at delays from diagnosis to start treatment in other cancers, and I think this just confirms how complicated those paths can be," she said. Those findings echo a national analysis, covered by Oncology Nursing News, showing that time from diagnosis to first treatment grew across 6 solid tumor types from 2012 to 2023, with longer waits among Black, uninsured, Medicaid-insured and lower-income patients.³

What are the key takeaways for oncology nurses?

• Track the clock. Monitor time from pathologic diagnosis to neoadjuvant chemotherapy against the 60-day mark.
• Coordinate workup early. Additional imaging, procedures and second opinions were the most common causes of delay.
• Address comorbidities in parallel. Comorbidity management accounted for nearly 1 in 5 delays.
• Give patients a roadmap. Outline next steps and where patients may need family or friends to help.
• Watch for inequities. Monitor time to treatment across patient groups.

References

1. Wooster M, Kulkarni A, Raghunathan RR, et al. Reasons for delay in receipt of neoadjuvant chemotherapy in patients with muscle invasive bladder cancer. JCO Oncol Pract. 2026;22(suppl):178. Presented at: 2026 ASCO Quality Care Symposium; October 16-17, 2026; Boston, MA.

2. Flaig TW. Clinical practice updates: navigating the new standard of care in bladder cancer. Oncology Nursing News. April 5, 2026. Accessed October 29, 2026. https://www.oncnursingnews.com/view/clinical-practice-updates-navigating-the-new-standard-of-care-in-bladder-cancer

3. ONN Staff. Cancer surgery waiting times rising: what oncology nurses need to know. Oncology Nursing News. August 20, 2026. Accessed October 29, 2026. https://www.oncnursingnews.com/view/cancer-surgery-waiting-times-rising-what-oncology-nurses-need-to-know