PD17-12 PATIENT COMPLIANCE WITH INTRAVESICAL MAINTENANCE PROTOCOLS FOR NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2015PD17-12 PATIENT COMPLIANCE WITH INTRAVESICAL MAINTENANCE PROTOCOLS FOR NON-MUSCLE INVASIVE BLADDER CANCER Alex Helfand, Liat Shavit Grievink, Daniel Kedar, Ofer Yossepowitch, Andrei Nadu, Eli Rosenbaum, Jack Baniel, and David Margel Alex HelfandAlex Helfand More articles by this author , Liat Shavit GrievinkLiat Shavit Grievink More articles by this author , Daniel KedarDaniel Kedar More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Andrei NaduAndrei Nadu More articles by this author , Eli RosenbaumEli Rosenbaum More articles by this author , Jack BanielJack Baniel More articles by this author , and David MargelDavid Margel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.669AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical therapy with Bacillus Calmette-Guerin (BCG) or Mitomycin C (MMC) is the mainstay of treatment for non-muscle invasive urothilial carcinoma of the bladder after initial transurethral resection. Evidence suggests that after an initial induction course maintenance protocols, typically given on a monthly or Lam (three weeks out of every three months) schedule, are important to reduce recurrence and progression. Limited data exists on patient compliance to maintenance protocols outside of clinical trials. We report our “real-life” experience with compliance to intravesical maintenance. METHODS We have compiled data on a cohort of patients who received intravesical therapy at Beilinson Hospital between 2000-2013. Patients were stratified to those treated with MMC and those treated with BCG. The primary outcome was patient compliance with maintenance treatment. “Non-compliance” was defined as termination of intravesical treatment without evidence of bladder tumor recurrence or progression. The possible predictors were patient related: age, gender, distance from hospital and ethnicity; as well as disease related: stage, grade and prior history of bladder cancer. We performed uni- and multivariable regression analyses to predict compliance to different maintenance protocols. RESULTS During the study period 1117 patients received intravesical treatment at our institution ( 713 (59.3%) with BCG and 441 (36.7%) with MMC ). There was no difference (84% vs. 86%) in the rate of completion of six weeks of induction between patients treated with BCG vs. MMC. Within the BCG cohort, 242 (33.9%) patients commenced the Lam maintenance protocol after induction and 24 (9.9% of the Lam group) completed all 21 Lam treatment over three years. A monthly protocol for BCG was started by 118 BCG patients (16.5%) and 61 of them (52%) completed all nine treatments. MMC therapy was started in 441 patients, 134 of whom (30.4%) commenced monthly maintenance treatment, and 62 (46.3% of 134) completed nine months of treatment. MMC patients received a mean of 6.62 monthly treatments and BCG patients received a mean of 6.87 monthly treatments, but the average patient on the BCG Lam protocol received a mean of 9.71 treatments. On multi-variable analysis, the only variable that was independently associated with compliance to maintenance protocol was a history of bladder cancer. This was noted for BCG, as well as MMC. CONCLUSIONS We demonstrated that compliance with maintenance protocols is poor. Further research is required to test whether compliance is also associated with outcome. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e385 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Helfand More articles by this author Liat Shavit Grievink More articles by this author Daniel Kedar More articles by this author Ofer Yossepowitch More articles by this author Andrei Nadu More articles by this author Eli Rosenbaum More articles by this author Jack Baniel More articles by this author David Margel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...