Improving Compliance With a Single Post-Operative Dose of Intravesical Chemotherapy After Transurethral Resection of Bladder Tumour

BACKGROUND - Post-operative single dose intravesical chemotherapy (PSDIVC) in patients with non-muscle invasive bladder cancer has been shown to reduce recurrence rates by up to 39%. However, some studies have suggested poor compliance with PSDIVC stating logistical issues and reluctance to give chemotherapy prior to histological confirmation as some of the reasons.

OBJECTIVE - This study aims to analyse appropriate administration of PSDIVC practice in St. Mary's Hospital against European Association of Urology guidelines and implement an intervention bundle to improve practice.

METHODS - All patients that underwent transurethral resection of bladder tumour (TURBT) between March 2012 and February 2013 were analysed retrospectively to review indication for post-operative chemotherapy, instillation rates and limiting factors preventing appropriate instillation. An intervention bundle including pre-operative delivery of mitomycin C (MMC) to the theatre suite, proforma placed in the operative notes and designated roles for PSDIVC induction was introduced to improve instillation and documentation rates. Prospective re-audit data was collected over six months between July 2013 and December 2013 following intervention.

RESULTS - Sixty-four patients in group A underwent TURBT prior to introduction of the intervention bundle. Fifty-four patients had non-muscle invasive bladder cancer (NMIBC), which would have been eligible for PSDIVC. Fifteen (28% of NMIBC) were administered PSDIVC. Twenty-three (36% of all patients) were either given PSDIVC or had a documented contraindication. Thirty-one patients in group B underwent TURBT following induction of intervention bundle. Twelve (50% of NMIBC) patients were given PSDIVC. Twenty-eight (90% of all patients) were either given PSDIVC or had a documented contraindication.

CONCLUSIONS - The intervention bundle prompted increased administration of PSDIVC and documentation. Similar centres may benefit from an intervention to improve compliance.

Nephro-urology monthly. 2016 Jan 16*** epublish ***

Luke Stroman, Ben Tschobotko, Hamid Abboudi, David Ellis, Elsie Mensah, Harikesh Kaneshayogan, Evangelos Mazaris

Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England., Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.