PD19-04 IMMEDIATE INTRAVESICAL CHEMOTHERAPY FOR LOW GRADE BLADDER TUMORS IN CALIFORNIA: AN UNDERUTILIZED PRACTICE AND ITS IMPACT ON RECURRENCE

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2017PD19-04 IMMEDIATE INTRAVESICAL CHEMOTHERAPY FOR LOW GRADE BLADDER TUMORS IN CALIFORNIA: AN UNDERUTILIZED PRACTICE AND ITS IMPACT ON RECURRENCE Stanley Yap, Ann Brunson, Neil Pugashetti, Rosemary Cress, Theresa Keegan, Ralph DeVere White, and Ted Wun Stanley YapStanley Yap More articles by this author , Ann BrunsonAnn Brunson More articles by this author , Neil PugashettiNeil Pugashetti More articles by this author , Rosemary CressRosemary Cress More articles by this author , Theresa KeeganTheresa Keegan More articles by this author , Ralph DeVere WhiteRalph DeVere White More articles by this author , and Ted WunTed Wun More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of intravesical chemotherapy (IC) immediately following transurethral resection of bladder tumor (TURBT) for low grade (LG) non muscle invasive bladder cancer (NMIBC) has been well demonstrated to reduce local recurrence and is supported by current guidelines. We sought to demonstrate patterns of uptake for this practice as well as its impact on outcomes at a population level as an initial step in developing quality improvement initiates in NMIBC. METHODS Incident cases of LG Ta or T1 NMIBC diagnosed between 2005 and 2012 were identified from the California Cancer Registry and linked to hospital records of the Office of Statewide Health Planning and Development. Tumor, patient, and hospital characteristics were included in the analysis. We determined rates of IC utilization following TURBT in patients with LG Ta or T1 NMIBC. Multivariable logistic regression models were utilized to determine predictors of IC utilization. Cumulative incidence functions and Cox Proportional Hazards (PH) models were used to determine predictors of recurrence-free survival (RFS), bladder cancer-specific survival (CSS), and overall survival (OS) with utilization of IC as the primary effector variable. RESULTS The final cohort consisted of 10,031 patients with LG NMIBC diagnosed in California between 2005 and 2012, with initial TURBT ≤ 45 days from diagnosis. The overall rate of IC utilization was 5.1%, but demonstrated an increase from 1.7% (2005-2006) to 9.6% (2011-2012). On multivariable logistic regression analysis, variables associated with increased odds of immediate IC instillation included more recent year of diagnosis (OR 1.74, CI 1.60-1.90 for 2 year increments). Factors associated with lower odds of receiving IC included Hispanic race (OR 0.62, CI 0.43-0.88) and Asian/Pacific Islander race (OR 0.58, CI 0.37-0.91). The cumulative incidence of recurrence at 24 months for patients who received IC was 25.2% compared to 30.2% among those that did not receive IC. On multivariable Cox PH analysis, use of IC was significantly associated with an 18% improvement in RFS (HR 0.82, CI 0.70-0.97). CONCLUSIONS Utilization of IC for LG NMIBC remains dismally low in routine practice, with less than 10% of patients receiving this standard of care even in more recent years. Poor utilization of this practice is associated with increased rates of recurrence. Strategies utilizing robust implementation of scientific methods should be studied as a means to overcome a major shortcoming in the quality of care provided to patients with LG NMIBC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e366 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stanley Yap More articles by this author Ann Brunson More articles by this author Neil Pugashetti More articles by this author Rosemary Cress More articles by this author Theresa Keegan More articles by this author Ralph DeVere White More articles by this author Ted Wun More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...