Abstract
MP76-02 OVERUSE OF CYSTOSCOPIC SURVEILLANCE AMONG PATIENTS WITH LOW-RISK NON-MUSCLE-INVASIVE BLADDER CANCER – A NATIONAL STUDY OF PATIENT, PROVIDER, AND FACILITY FACTORS
The Journal of urology, Vol.199(4S), pp.e1018-e1018
04/2018
DOI: 10.1016/j.juro.2018.02.2570
Abstract
INTRODUCTION AND OBJECTIVES
Since 2005, multiple panels have recommended no more than 3 cystoscopies in the first 2 years after diagnosis for patients with low-risk non-muscle-invasive bladder cancer (NMIBC). We hypothesized that - despite these recommendations - many patients receive too much cystoscopic surveillance. We sought to understand the extent of overuse and to examine patient, provider, and facility factors contributing to it, potentially identifying targets for improvement.
METHODS
Using a validated natural language processing algorithm, we included patients diagnosed with low-risk (i.e., low-grade Ta) NMIBC 2005 to 2011 from the national Department of Veterans Affairs database. Patients were followed until cancer recurrence, death, last contact, or for 2 years after diagnosis. Procedure codes were used to enumerate cystoscopy procedures during follow-up. Based on guideline recommendations and length of follow-up, overuse of cystoscopic surveillance was defined as >1 cystoscopy if followed less than 1 year, >2 cystoscopies if followed 1 to less than 2 years, or >3 cystoscopies if followed for 2 years after diagnosis. We identified patient, provider, and facility factors associated with overuse using multivariable generalized estimating equations.
RESULTS
We found overuse of cystoscopy among 75% of patients (905 of 1,206). This included 81% of 280 patients followed <1 year, 85% of 227 patients followed 1 to <2 years, and 69% of 699 patients followed for 2 years. Overuse remained common over the study period (75% of patients diagnosed in 2011). Of 14 factors assessed, few were associated with overuse of cystoscopy: earlier year of diagnosis, white vs. other/missing race, comorbidity, and an attending vs. resident provider (Table).
CONCLUSIONS
Overuse of cystoscopy among patients with low-risk NMIBC is common, raising concerns about quality and cost of bladder cancer surveillance. However, we found few patient and provider factors associated with overuse. The association of earlier year of diagnosis with overuse suggests lack of knowledge of surveillance recommendations as a potential cause. However, further qualitative research is needed to confirm this hypothesis and to identify other determinants of overuse not captured in administrative data.
Details
- Title: Subtitle
- MP76-02 OVERUSE OF CYSTOSCOPIC SURVEILLANCE AMONG PATIENTS WITH LOW-RISK NON-MUSCLE-INVASIVE BLADDER CANCER – A NATIONAL STUDY OF PATIENT, PROVIDER, AND FACILITY FACTORS
- Creators
- David Han - Lebanon, NHAmanda Swanton - Lebanon, NHKristine Lynch - Salt Lake City, UTJi Won Chang - Salt Lake City, UTBrenda Sirovich - Lebanon, NHDouglas Robertson - Lebanon, NHJohn Seigne - Lebanon, NHPhilip Goodney - Lebanon, NHFlorian Schroeck - Lebanon, NH
- Resource Type
- Abstract
- Publication Details
- The Journal of urology, Vol.199(4S), pp.e1018-e1018
- Publisher
- ELSEVIER SCIENCE INC
- DOI
- 10.1016/j.juro.2018.02.2570
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Grant note
Dept of Veterans Affairs VISN 1 Career Development Award; Conquer Cancer Foundation Career Development Award; Dartmouth-Hitchcock Dept of Surgery internal Career Development Award
- Language
- English
- Date published
- 04/2018
- Academic Unit
- Urology
- Record Identifier
- 9984701740102771
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