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Urology: Compliance with Bladder Cancer Guidelines Poor

by Erin Moore

A recent study published on the Cancer website sheds light on the marked underuse of guideline-based care in patients with bladder cancer.

Bladder cancer is the fifth most frequent malignancy, requires close surveillance, and is the most expensive cancer to treat per patient. Several respected organizations, including the National Comprehensive Cancer Center and the American Urological Association, have established best-practice guidelines to address the high morbidity and mortality. However, practice patterns do not reflect their adoption. The authors of the current study sought more information. They used the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked database of the National Cancer Institute to identify patients 66 years or older who were diagnosed with high-grade urothelial non-muscle invasive bladder cancer between January 1, 1982 and December 31, 2002.

Out of 4,545 patients from 1,536 provider practices and 667 institutions across the United States, the authors found only one case of comprehensive compliance. Publication of clinical practice guidelines did not significantly increase the percentage of patients who received compliant care. There was no statistically significant increase in provider compliance either; in fact, the number of providers who had used at least eight cytologies decreased. The authors concluded that “clinically effective measures are not readily practiced through the mere publication of best-practice guidelines. In the absence of a broad quality improvement initiative, the diffusion of clinically effective care will be slow, and many more unnecessary disease recurrences, procedures, and deaths will be realized. This is an especially critical point because progress in preventing bladder cancer-related mortality lags behind other diseases.”

Source: Chamie K, Saigal CS, Lai J, et al. 2011. Compliance with guidelines for patients with bladder cancer: variation in the delivery of care. Published on July 11, 2011 on the Cancer website.