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[ ]in my own academic work, I have complained about the number of urologists who fail to offer neoadjuvant chemotherapy - which is wellsupported by level-one data - citing insufficient robustness of the patient, while feeling comfortable to complete a radical cystectomy [ ]as reported by Crawford and colleagues, many health insurance companies have set standard operating procedures that do not allow reordering of the medications in a timely fashion, thus interfering with on-time delivery The problem is much more widespread, and all of us involved in treatment of cancer are only too familiar with the delays created by payers - excessive documentation requirements, small-print rules that delay pre-approvals and approvals, requirements to secure approvals from family practitioners who have become the insurance gatekeepers, and obstructions to complaints and/or litigation
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