Adherence to surveillance among patients with superficial bladder cancer Journal Article
| Authors: | Schrag, D.; Hsieh, L.; Rabbani, F.; Bach, P. B.; Herr, H.; Begg, C. B. |
| Article Title: | Adherence to surveillance among patients with superficial bladder cancer |
| Abstract: | Background: Patients diagnosed with superficial bladder cancer who have not undergone total cystectomy are at high risk for recurrence, and bladder surveillance with cystoscopy is recommended for such patients every 3-6 months. We examined the degree to which bladder cancer patients undergo the recommended surveillance procedures and identified patient and primary care provider characteristics associated with nonadherence to these recommendations. Methods: We used information obtained from the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare-linked database to identify 6717 patients aged 65 years or older who were diagnosed with superficial bladder cancer from 1992 through 1996 and who survived for at least 3 years after diagnosis but did not have a total cystectomy. We used information obtained from Medicare claims forms to examine the frequency with which these patients had a surveillance examination of the bladder during each of five contiguous 6-month intervals from month 7 to month 36 following diagnosis. We examined characteristics of patients and their physicians that were associated with low-intensity surveillance (defined as having an examination during fewer than two of the five possible follow-up intervals). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: Only 40% of the entire cohort had an examination during all five intervals; 1216 patients (18.1%) had low-intensity surveillance. Patient characteristics that were independently associated with low-intensity surveillance were being age 75 years or older (adjusted OR = 1.54, 95% CI = 1.35 to 1.74), nonwhite (adjusted OR = 1.94, 95% CI = 1.57 to 2.40), and having favorable tumor histology (adjusted OR = 0.59, 95% CI = 0.48 to 0.72 for poorly differentiated versus referent well-differentiated tumor grade) and high comorbidity (adjusted OR = 1.72, 95% CI = 1.30 to 2.27). Residence in an urban area or in a census tract with low median income was also associated with low-intensity surveillance. Conclusions: The actual practice of surveillance for patients with superficial bladder cancer differs substantially from the standards recommended in clinical guidelines. |
| Keywords: | cancer survival; controlled study; aged; aged, 80 and over; major clinical study; histopathology; cancer recurrence; united states; cancer patient; recurrence risk; follow up; cancer grading; clinical practice; demography; tumor differentiation; cohort analysis; odds ratio; recurrence; practice guideline; data base; bladder cancer; urinary bladder neoplasms; age; risk assessment; risk; health care quality; health program; medicare; patient information; statistical analysis; physicians; cystectomy; comorbidity; patient compliance; seer program; cystoscopy; physician attitude; guideline adherence; logistic regression analysis; population surveillance; patient attitude; primary medical care; negro; periodic medical examination; lowest income group; practice guidelines; urban area; humans; human; male; female; priority journal; article |
| Journal Title: | JNCI: Journal of the National Cancer Institute |
| Volume: | 95 |
| Issue: | 8 |
| ISSN: | 0027-8874 |
| Publisher: | Oxford University Press |
| Date Published: | 2003-04-16 |
| Start Page: | 588 |
| End Page: | 597 |
| Language: | English |
| PUBMED: | 12697851 |
| PROVIDER: | scopus |
| DOI: | 10.1093/jnci/95.8.588 |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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