Overuse of Cystoscopic Surveillance Among Patients With Low-risk Non-Muscle-invasive Bladder Cancer - A National Study of Patient, Provider, and Facility Factors

David S Han; Kristine E Lynch; Ji Won Chang; Brenda Sirovich; Douglas J Robertson; Amanda R Swanton; John D Seigne; Philip P Goodney; Florian R Schroeck

doi:10.1016/j.urology.2019.04.036

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Overuse of Cystoscopic Surveillance Among Patients With Low-risk Non-Muscle-invasive Bladder Cancer - A National Study of Patient, Provider, and Facility Factors

Journal article

Peer reviewed

Overuse of Cystoscopic Surveillance Among Patients With Low-risk Non-Muscle-invasive Bladder Cancer - A National Study of Patient, Provider, and Facility Factors

David S Han, Kristine E Lynch, Ji Won Chang, Brenda Sirovich, Douglas J Robertson, Amanda R Swanton, John D Seigne, Philip P Goodney and Florian R Schroeck

Urology (Ridgewood, N.J.), Vol.131, pp.112-119

09/01/2019

DOI: 10.1016/j.urology.2019.04.036

PMCID: PMC6711796

PMID: 31145947

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Abstract

To understand cystoscopic surveillance practices among patients with low-risk non-muscle-invasive bladder cancer (NMIBC) within the Department of Veterans Affairs (VA). Using a validated natural language processing algorithm, we included patients newly diagnosed with low-risk (ie low-grade Ta) NMIBC from 2005 to 2011 in the VA. Patients were followed until cancer recurrence, death, last contact, or 2 years after diagnosis. Based on guidelines, surveillance overuse was defined as >1 cystoscopy if followed <1 year, >2 cystoscopies if followed 1 to <2 years, or >3 cystoscopies if followed for 2 years. We identified patient, provider, and facility factors associated with overuse using multilevel logistic regression. Overuse occurred in 75% of patients (852/1135) - with an excess of 1846 more cystoscopies performed than recommended. Adjusting for 14 factors, overuse was associated with patient race (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.28, 0.85 unlisted race vs White), having 2 comorbidities (OR 1.60, 95% CI: 1.00, 2.55 vs no comorbidities), and earlier year of diagnosis (OR 2.50, 95% CI: 1.29, 4.83 for 2005 vs 2011, and OR 2.03, 95% CI: 1.11, 3.69 for 2006 vs 2011). On sensitivity analyses assuming all patients were diagnosed with multifocal or large low-grade tumors (ie, intermediate-risk), overuse would have still occurred in 45% of patients. Overuse of cystoscopy among patients with low-risk NMIBC was common, raising concerns about bladder cancer surveillance cost and quality. However, few factors were associated with overuse. Further qualitative research is needed to identify other determinants of overuse not readily captured in administrative data.

Aged

Cohort Studies

Cystoscopy - statistics & numerical data

Female

Humans

Male

Neoplasm Invasiveness

Procedures and Techniques Utilization - statistics & numerical data

Retrospective Studies

Risk Assessment

United States

Urinary Bladder Neoplasms - epidemiology

Urinary Bladder Neoplasms - pathology

Watchful Waiting

Details

Title: Subtitle: 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 S Han - Dartmouth Institute for Health Policy and Clinical Practice
Kristine E Lynch - University of Utah
Ji Won Chang - University of Utah
Brenda Sirovich - White River Junction VA Medical Center
Douglas J Robertson - White River Junction VA Medical Center
Amanda R Swanton - Dartmouth–Hitchcock Medical Center
John D Seigne - Dartmouth–Hitchcock Medical Center
Philip P Goodney - White River Junction VA Medical Center
Florian R Schroeck - Dartmouth Institute for Health Policy and Clinical Practice
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.131, pp.112-119
DOI: 10.1016/j.urology.2019.04.036
PMID: 31145947
PMCID: PMC6711796
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Grant note: I01 HX001880 / HSRD VA
Language: English
Date published: 09/01/2019
Academic Unit: Urology
Record Identifier: 9984701552202771

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