Adherence to surveillance guidelines after radical cystectomy: A population-based analysis Journal Article
| Authors: | Ehdaie, B.; Atoria, C. L.; Lowrance, W. T.; Herr, H. W.; Bochner, B. H.; Donat, S. M.; Dalbagni, G.; Elkin, E. B. |
| Article Title: | Adherence to surveillance guidelines after radical cystectomy: A population-based analysis |
| Abstract: | Objectives: Surveillance after radical cystectomy is recommended to detect tumor recurrence and treatment complications. We evaluated adherence to National Comprehensive Cancer Network (NCCN) guidelines using a large population-based database. Methods and materials: The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients aged ≥66 years diagnosed with nonmetastatic bladder cancer who had undergone radical cystectomy between 2000 and 2007. Medicare claims information identified recommended surveillance tests for 2 years after cystectomy as outlined in the NCCN guidelines. Adherence was defined as receipt of urine cytology and imaging of the chest, abdomen, and pelvis in each year. We evaluated the effect of patient and provider characteristics on adherence, controlling for demographic and disease characteristics. Results: Of 3,757 patients who had undergone radical cystectomy, 2,990 (80%) were alive after 2 years. Adherence to all recommended investigations was 17% for the first and the second years following surgery. Among patients surviving 2 years, only 9% had complete surveillance in both years. In either year, adherence was less likely in patients with advanced pathologic stage (III/IV) (adjusted odds ratio [AOR] = 0.74, 95% CI: 0.60-0.91) and unmarried patients (AOR = 0.82, 95% CI: 0.68-0.99). Adherence was more likely in patients treated by high-volume surgeons (AOR = 2.00, 95% CI: 1.70-2.36) and those who saw a medical oncologist (AOR = 1.52, 95% CI: 1.27-1.82). We also observed significant geographic variability in adherence. Conclusion: Patterns of surveillance after radical cystectomy deviate considerably from NCCN recommendations. Despite increased utilization of radiographic imaging investigations, the omission of urine cytology significantly contributed to the low rate of overall adherence to surveillance guidelines. Uniform adherence to surveillance guidelines was observed in patients treated by high-volume surgeons. This suggests an important opportunity for quality improvement in bladder cancer care. © 2014 Elsevier Inc. |
| Keywords: | cancer chemotherapy; aged; medical oncologist; major clinical study; cancer recurrence; postoperative period; advanced cancer; cancer staging; recurrence risk; lymph node metastasis; practice guideline; diagnostic imaging; bladder cancer; medicare; population research; total quality management; surgeon; radical cystectomy; cystectomy; patient compliance; cancer registry; cancer epidemiology; guidelines; surveillance; urine cytology; health outcomes; charlson comorbidity index; human; male; female; priority journal; article |
| Journal Title: | Urologic Oncology: Seminars and Original Investigations |
| Volume: | 32 |
| Issue: | 6 |
| ISSN: | 1078-1439 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-08-01 |
| Start Page: | 779 |
| End Page: | 784 |
| Language: | English |
| DOI: | 10.1016/j.urolonc.2014.01.024 |
| PROVIDER: | scopus |
| PUBMED: | 24935876 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2014 -- CODEN: UOSOA -- Source: Scopus |
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