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    NMIBC guideline compliance remains low

    Urologists’ compliance with nonmuscle-invasive bladder cancer guidelines has improved with respect to delivery of perioperative mitomycin, but other care measures continue to be suboptimal, according to a new study presented at the AUA annual meeting in Boston.

    The AUA released its nonmuscle-invasive bladder cancer management guidelines in 1999, along with updates in 2007 and 2016. But urologists’ compliance with the guidelines has never been good. A study by Chamie et al suggested suboptimal compliance among physicians in the specialty from 1992 to 2002. And in this update, little had changed, except urologists’ improving compliance with the delivery of perioperative mitomycin.

    Read: Software could help prevent post-cystectomy readmission

    The findings suggest more is needed to disseminate and implement guideline-based care, according to the authors.

    “Treatment guidelines exist for managing cancer patients based on the best available evidence. It is important to measure compliance with guideline-based practices to define what is happening in ‘real-world’ practice and where there are care gaps between recommended guidelines and actual practice,” said senior author Ken Nepple, MD, of the University of Iowa Health Care, Iowa City.

    “Specifically in high-grade nonmuscle-invasive bladder cancer, there is an association where patients who have higher compliance with guideline-based care have improved survival. That association, which is likely a result of both patient-specific and treatment-specific effects, should prompt urologists to continue to try and adhere to guidelines whenever possible.”

    But, as the study implies, making big changes in practice isn’t easy, according to Dr. Nepple.

    The authors referred to the Surveillance, Epidemiology, and End Results-Medicare 1992-2009 database to identify 865 Iowans who had been diagnosed with high-grade nonmuscle-invasive bladder cancer, survived 2 years, and had not had cystectomy or radiation therapy. During 2 years’ follow-up, the authors assessed whether the patients had received guideline-based care, including perioperative mitomycin C, instillations, cystoscopy, cytology, and bacillus Calmette-Guerin (BCG), according to the study.

    Next: Only 40% of those studied received at least one cystoscopy, one cytology, and one BCG instillation

    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.


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