Variability in adherence to guidelines based management of nonmuscle invasive bladder cancer among Society of Urologic Oncology (SUO) members.

Abstract

PURPOSE:

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.

METHODS AND MATERIALS:

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.

RESULTS:

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).

CONCLUSION:

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.

• Authors: 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
• Journal: Urologic oncology (Urol Oncol) Vol. 38 Issue 10 Pg. 796.e1-796.e6 (10 2020) ISSN: 1873-2496 [Electronic] United States
• PMID: 32430255 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers, Tumor

Topics

• Biomarkers, Tumor (analysis)
• Cystectomy
• Cystoscopy (standards, statistics & numerical data)
• Disease Progression
• Evidence-Based Medicine (standards, statistics & numerical data)
• Guideline Adherence (statistics & numerical data)
• Humans
• Medical Oncology (standards, statistics & numerical data)
• Medical Overuse (statistics & numerical data)
• Muscle, Smooth (diagnostic imaging, pathology, surgery)
• Neoplasm Grading
• Neoplasm Recurrence, Local (diagnosis, pathology, prevention & control)
• Neoplasm Staging
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (standards, statistics & numerical data)
• Risk Assessment
• Societies, Medical (standards, statistics & numerical data)
• Surveys and Questionnaires (statistics & numerical data)
• Urinary Bladder (diagnostic imaging, pathology, surgery)
• Urinary Bladder Neoplasms (diagnosis, pathology, therapy)
• Urology (standards, statistics & numerical data)
• Watchful Waiting (standards, statistics & numerical data)