Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State

Conrad M Tobert; Kenneth G Nepple; Bradley D McDowell; Mary E Charlton; Sarah L Mott; Thomas S Gruca; Laura Quast; Bradley A Erickson

doi:10.1016/j.urology.2019.06.021

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Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State

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Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State

Conrad M Tobert, Kenneth G Nepple, Bradley D McDowell, Mary E Charlton, Sarah L Mott, Thomas S Gruca, Laura Quast and Bradley A Erickson

Urology (Ridgewood, N.J.), Vol.132, pp.150-155

10/2019

DOI: 10.1016/j.urology.2019.06.021

PMCID: PMC6916249

PMID: 31252002

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Abstract

To identify factors associated with nonmuscle invasive bladder cancer (NMIBC) American Urological Association (AUA) guideline compliance in a rural state, to evaluate compliance rates over time, and to assess the impact of patient and provider rurality on delivery of NMIBC care. We identified 847 Iowans in Surveillance, Epidemiology, and End Results-Medicare from 1992 to 2009 with high-grade NMIBC who survived 2 years and were not treated with cystectomy or radiation during this period. Compliance with AUA guidelines was assessed over time and compared to patient demographic, tumor, and treatment institution variables. Impact of rurality was analyzed using Surveillance, Epidemiology, and End Results ZIP code data travel distance of patient to nearest urologist practice location. Overall compliance with AUA guidelines was low (<1%), and did not markedly improve over the study period. In the multivariable model, only care at an academic medical center (OR 11.68, 95% CI 7.07-19.29) and tumor stage (Tis; OR 3.24, 95% CI 1.86-5.63) increased the odds of compliance. Patients living closer (<10 miles) to their urologists underwent more cystoscopies than patients living further (>30 miles) but distance did not affect compliance with other measures. Compliance was not associated with cancer-specific survival. Compliance with post-Transurethral Resection of Bladder Tumor (TURBT) NMIBC treatment guidelines has improved but remains suboptimal in our rural state, and is highly associated with treatment at an academic cancer center for reasons that could not be fully explained with these data.

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Title: Subtitle: Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State
Creators: Conrad M Tobert - University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
Kenneth G Nepple - University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
Bradley D McDowell - University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
Mary E Charlton - University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
Sarah L Mott - University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
Thomas S Gruca - University of Iowa, Tippie College of Business, Iowa City, IA
Laura Quast - University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
Bradley A Erickson - University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.132, pp.150-155
DOI: 10.1016/j.urology.2019.06.021
PMID: 31252002
PMCID: PMC6916249
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Publisher: Elsevier Inc
Grant note: P30 CA086862 / HCCC Population Research and Biostatistics Cores 062761671 / American Urological Association Data
Language: English
Date published: 10/2019
Academic Unit: Marketing; Epidemiology; Urology; Holden Comprehensive Cancer Center
Record Identifier: 9984214815202771

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