To identify factors associated with non-muscle invasive bladder cancer (NMIBC) AUA guideline compliance in a rural state, to evaluate compliance rates over time, and to assess the impact of patient and provider rurality on delivery of NMIBC care.
We identified 847 Iowans in Surveillance, Epidemiology, and End Results (SEER)-Medicare from 1992 to 2009 with high-grade NMIBC who survived 2 years and were not treated with cystectomy or radiation during this period. Compliance with AUA guidelines was assessed over time and compared to patient demographic, tumor, and treatment institution variables. Impact of rurality was analyzed using SEER ZIP code data travel distance of patient to nearest urologist practice location.
Overall compliance with AUA guidelines was low (<1%), and did not markedly improve over the study period. In the multivariable model, only care at an academic medical center (OR 11.68, 95% CI 7.07 - 19.29) and tumor stage (Tis; OR 3.24, 95% CI 1.86 - 5.63) increased the odds of compliance. Patients living closer (<10 miles) to their urologists underwent more cystoscopies than patients living further (>30 miles) but distance did not affect compliance with other measures. Compliance was not associated with cancer specific survival.
Compliance with post-TURBT NMIBC treatment guidelines has improved but remains suboptimal in our rural state, and is highly associated with treatment at an academic cancer center for reasons that could not be fully explained with these data.
Urology. 2019 Jun 25 [Epub ahead of print]
Conrad M Tobert, Kenneth G Nepple, Bradley D McDowell, Mary E Charlton, Sarah L Mott, Thomas S Gruca, Laura Quast, Bradley A Erickson
University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA., University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA; University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA., University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA., University of Iowa, Tippie College of Business, Iowa City, IA., University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA. Electronic address: .