Department of Urology
University of Alberta
Adherence to guidelines in the management of high-risk non-muscle-invasive bladder cancer - Are patients receiving intravesical Bacillus Calmette-Guérin therapy appropriately?
Betty Wang1, Benjamin Beech1, Sentil Senthilselvan2, Howard J. Evans1.
1Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada; 2School of Public Health, University of Alberta, Edmonton, AB, Canada
Introduction: High risk non-muscle invasive bladder cancer (HR-NMIBC) is defined as all tumours with T1 stage, CIS, or high grade (HG). In this setting, Bacillus Calmette-Guérin (BCG) intravesical therapy is the standard of care, which comprise of both an induction course over 6 weeks, with a maintenance course over 3 years. We aim to determine the adherence to this level 1A recommendation in our center, and to identify predictors associated with utilization of BCG.
Methods: We performed a retrospective review of patients receiving transurethral resection of bladder tumors (TURBT) between November 2009 to November 2014. Patients were included if they had HR-NMIBC. We determined whether these patients received BCG and if so, the duration of treatment. We also collected relevant clinical variables which were felt could potentially influence the utilization of BCG. These included patient factors such as age and gender, as well as disease factors such as stage, grade, presence of variant histology, and history of prior interventions. We performed a multivariable analysis using logistic regression models to identify any correlation between BCG utilization and any of the clinical variables.
Results: A total of 608 patients were identified as having HR-NMIBC. 76% of patients had no prior surgery for their bladder cancer. 91% of patients never received prior BCG. Of all patients with HR-NMIBC, 59% of patients received BCG. Using multivariate logistic regression models, age, T-stage and surgeon volume were associated with BCG therapy. Number of prior TURBTs and history of prior BCG therapy was not associated with BCG therapy.
Conclusion: In summary, data showed that 59% of patients with HR-NMIBC received some duration of BCG. Age, T-stage and surgeon were identified as predictors of BCG therapy. Given this data, we have identified a gap for future quality improvement. More work is needed to help improve uptake of BCG therapy in the clinically appropriate patient.