PURPOSE OF STUDY: The standard treatment for muscle-invasive bladder cancer is radical cystectomy (RC). Prior studies demonstrated that delays from diagnosis to surgery greater than 12 weeks result in higher mortality, higher pathological tumour stage, and worse progression-free survival. We sought to validate adverse outcomes associated with delays in care in the current treatment paradigm that includes neoadjuvant chemotherapy (NAC) and identify patient, provider, and health systems characteristics that correlate with a delay of treatment. METHODS USED: Subjects were identified from the Surveillance, Epidemiology, and End Results (SEER) national cancer registry linked with Medicare claims. All patients with American Joint Committee on Cancer stage II (T2N0-1M0) urothelial cell carcinoma of the urinary bladder who underwent RC from 2004–2011 were stratified into treatment with or without NAC. Variable selection was derived from Andersen’s behavioural model of healthcare utilisation and included demographics, medical need, and provider/health system factors. Cox multivariate proportional hazard models were constructed to assess the significance of a delay in care on survival. Multivariate logistic regression was used to identify independent characteristics associated with a delay in care. SUMMARY OF RESULTS: 1641 subjects with stage II bladder cancer underwent RC during the study period. Compared with timely surgery (RC within 12 weeks of diagnosis), a delay in care increased the risk of overall mortality (HR 1.34, p=0.02; HR 1.55, p=0.045, for no NAC and NAC cohorts, respectively). Without NAC, those with a delay in care were more likely to live in a high-poverty neighbourhood (p=0.045) or a non-metro area (p=0.03), be male (p=0.005), and have required a transfer in bladder cancer care (p=0.02). These associations were not observed in the NAC group, who were younger (p<0.001) and received care from higher volume RC providers (p=0.008). CONCLUSIONS: Delays in care from diagnosis or NAC to RC are associated with decreased survival among patients with stage II bladder cancer. These delays are associated with male gender, living in a high-poverty neighbourhood or non-metro area, and transfers in care from biopsy to RC in patients without NAC. This was not observed in patients with NAC as they may represent a subset of bladder cancer patients who are effective healthcare users.