UP-27 Uptake of reTUR in T1 bladder cancer in Ontario: an interrupted time series analysis involving 15 years of observation
Thursday June 27, 2019 from
TBD
Presenter

Marian S. Wettstein, Canada

Research Fellow

Surgical Oncology

Princess Margaret Cancer Center - University Health Network

Abstract

Uptake of reTUR in T1 bladder cancer in Ontario: An interrupted time series analysis involving 15 years of observation

Marian S. Wettstein1,2,3,4, Nancy N. Baxter2,3, Rinku Sutradhar2,3, Muhammad M. Mamdani2,3, Song Pham3, Syed R. Qadri1, Kathy Li1, Ning Liu3, van der Kwast Theodorus5, Thomas Hermanns4, Girish S. Kulkarni1,2,3.

1Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada; 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; 3ICES, Toronto, ON, Canada; 4Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; 5Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada

Introduction: A second transurethral resection of the bladder tumor (reTUR) within 2-6 weeks after initial resection is thought to have diagnostic, therapeutic, and prognostic benefits in T1 bladder cancer. However, little is known about the real-world uptake of this guideline-endorsed intervention. We aimed (1) to measure reTUR rates over time, (2) to investigate if a guideline revision (April 2008) explicitly endorsing reTUR within 2-6 weeks in all T1 bladder cancer patients led to an increase in reTUR rates, and (3) to investigate the uptake among different groups of surgeons.

Methods: Province-wide bladder cancer pathology reports (January 2001 to December 2015; Ontario, Canada) were manually abstracted and linked with health administrative data to (1) identify primary cases of T1 bladder cancer and to (2) ascertain whether these patients received reTUR. The resulting patients were then aggregated into quarterly time series and investigated by descriptive analysis, ARIMA modeling, and Poisson regression analysis.

Results: A cohort of 7373 patients was aggregated into a time series. We observed a linear increase in reTUR rates from 8.4% in 2001 to 28.3% in 2015. An actual effect of the guideline revision in April 2008 on reTUR rates could not be detected (p=0.41). However, we observed a rather heterogeneous uptake behavior among different groups of surgeons. Specifically, female surgeons, more junior surgeons, high-volume surgeons, Canadian graduates, and surgeons without an academic affiliation were all independently more likely to perform reTUR (all p<0.05 in adjusted analysis).

Conclusions: ReTUR rates in primary T1 bladder cancer increased between 2001 and 2015 in Ontario regardless of the guideline revision in April 2008. Our study demonstrates that the uptake of this guideline-endorsed intervention varies among different groups of surgeons and therefore warrants further research to identify barriers to change that can be addressed by tailored interventions.


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