The American Urological Association (AUA) introduced evidence-based guidelines for the management of nonmuscle invasive bladder cancer (NMIBC) in 2016. We sought to assess the implementation of these guidelines among members of the Society of Urologic Oncology (SUO) with an aim to identifying addressable gaps.
An SUO approved survey was distributed to 747 members from December 28, 2018 to February 2, 2019. This 14-question online survey (Qualtrics, SAP SE, Germany) consisted of 38 individual items addressing specific statements from the AUA NMIBC guidelines within 3 broad categories - initial diagnosis, surveillance, and imaging/biomarkers. Adherence to guidelines was assessed by dichotomizing responses to each item that was related to recommended action statement within the guidelines. Statistical analysis was applied using Pearson's chi-squared test, where a P-value of <0.05 was considered statistically significant.
A total of 121 (16.2%) members completed the survey. Members reported a mean of 71% guidelines adherence; adherence was higher for the intermediate- and high-risk subgroups (82% and 76%, respectively) compared to low-risk (58%). Specifically, adherence to guideline recommended cystoscopic surveillance intervals for low-risk disease differed based on clinical experience (60.9% [<10 years] vs. 36.8% [≥10 years], P = 0.01) and type of fellowship training (55.2% [urologic oncology] vs. 28.0% [none/other], P = 0.02).
Adherence to guidelines across risk-categories was higher for intermediate- and high-risk patients. Decreased adherence observed for low-risk patients resulted in higher than recommended use of cytology, imaging, and surveillance cystoscopy. These results identify addressable gaps and provide impetus for targeted interventions to support high-value care, especially for low-risk patients.
Urologic oncology. 2020 May 16 [Epub ahead of print]
Justin T Matulay, William Tabayoyong, Jonathan J Duplisea, Courtney Chang, Siamak Daneshmand, John L Gore, Jeffrey M Holzbeierlein, Lawrence I Karsh, Simon P Kim, Badrinath R Konety, Roger Li, James M McKiernan, Edward M Messing, Gary D Steinberg, Stephen B Williams, Ashish M Kamat
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urology, University of Rochester Medical Center, Rochester, NY., Division of Urology, Department of Surgery, UTHealth McGovern Medical School, Houston, TX., USC Institute of Urology, University of Southern California, Los Angeles, CA., Department of Urology, University of Washington School of Medicine, Seattle, WA., Department of Urology, University of Kansas Medical Center, Kansas City, KS., The Urology Center of Colorado, Denver, CO., Division of Urology, University of Colorado, Aurora, CO., Department of Urology, University of Minnesota, Minneapolis, MN., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL., Department of Urology, Columbia University Irving Medical Center, New York, NY., Department of Urology, New York University Langone Medical Center, New York, NY., Division of Urology, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, TX., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32430255
Go Beyond the Abstract and Read a Commentary by Dr. Ashish Kamat