ASCO GU 2017: Quality of care in non-muscle invasive bladder cancer: optimizing surgical and medical therapies - Session Highlights
Orlando, Florida USA (UroToday.com) Karim Chamie, UCLA, discussed the quality care for non-muscle invasive bladder cancer. There is a significant health burden associated with bladder cancer care. The burden of recurrence and death assessed in approximately 7,400 patients found a large number of non-muscle invasive bladder cancer patients die with their disease. Quality of endoscopic resection was assessed in 1,865 patients with 52% ‘muscle mentioned and present’ in pathology report with ‘muscle absent’ associated with decreased survival. Use of mitomycin C (MMC) is associated with cost savings of approximately $200/patient, however, there is lower utilization of MMC noted among urologists. Moreover, only 1/3 urologists have been noted to administer any kind of intravesical therapy after diagnosis of non-muscle invasive bladder cancer. Use of BCG is even more dismal. Surveillance quality assessment showed out of over 4,000 patients only 1 patient received the guideline recommended follow-up. Further efforts are needed in this population to improve surveillance adherence. Further highlighting poor quality of definitive treatment when needed in this population, only 25% of patients undergo definitive treatment after multiple recurrences. Practice patterns are impacted by reimbursement and further modifying reimbursement modeling may improve practice patterns in concordance with guideline recommendations. Non-compliance is common and multifactorial. Further research are needed to identify determinants to improve adherence and bladder cancer outcomes.
Presenter: Karim Chamie, MD, MSHS, University of California, Los Angeles
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX