Perioperative Intravesical Chemotherapy for Patients with Non-Muscle Invasive Bladder Cancer: Understanding the Extent of and Sources of Variation in Guideline-Recommended Use

To examine intravesical chemotherapy (IVC) use according to non-muscle invasive bladder cancer (NMIBC) patient disease risk, and the contributions of multi-level factors to variation in proficient use among patients with low-intermediate disease.

This study included 988 patients diagnosed with NMIBC in an integrated health system in Northern California from 2015-2017. We calculated IVC receipt by disease risk, and among patients with low-intermediate risk disease, assessed the relationship between multi-level factors and IVC receipt using a logistic regression model with random intercepts for provider and service area, and patient-, provider-, and service area-level fixed effects. We further assessed the association of provider- and service area-level factors with IVC use by examining intra-class correlation coefficients (ICCs).

Similar proportions of low-intermediate (36%) and high-risk (34%) patients received IVC. In the multivariate analysis including low-intermediate risk patients, service area volume was strongly and statistically significantly associated with IVC use (aOR, high- v. low-volume: 0.08, 95% CI: 0.01-0.58). Provider- and service area-level ICCs were large, (38%, p=0.0009 and 39% p=0.03, respectively) indicating that much of the variance in IVC use was explained by factors at these levels.

Our findings highlight opportunities to improve proficient use of IVC. Future research should assess provider- and practice-level barriers to IVC use among low-intermediate risk patients.

Urology. 2018 Oct 22 [Epub ahead of print]

Devon K Check, David S Aaronson, Matthew E Nielsen, Valerie S Lee, Isaac J Ergas, Janise M Roh, Lawrence H Kushi, Li Tang, Marilyn L Kwan

Kaiser Permanente Northern California Division of Research. Electronic address: ., Department of Urology, Kaiser Permanente Northern California Oakland Medical Center. Electronic address: ., Department of Urology, University of North Carolina at Chapel Hill. Electronic address: ., Kaiser Permanente Northern California Division of Research. Electronic address: ., Kaiser Permanente Northern California Division of Research. Electronic address: ., Kaiser Permanente Northern California Division of Research. Electronic address: ., Kaiser Permanente Northern California Division of Research. Electronic address: ., Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Institute. Electronic address: ., Kaiser Permanente Northern California Division of Research. Electronic address: .

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