A retrospective study of 2,044 patients with bladder cancer treated with cystectomy in the Ontario Cancer Registry showed that utilization of adjuvant chemotherapy increased from 1994–1998 (16%), to 1999–2003 (18%) and to 2004–2008 (22%), while utilization of neoadjuvant chemotherapy remained stable (mean rate 4%). Adjuvant chemotherapy was associated with improved overall survival and cancer-specific survival, and was more likely to be given to patients with T3–T4 disease or positive nodes.