Results of a Questionnaire-Based Study on Guideline Adherence Regarding Adjuvant Treatment Recommendations for Patients with Non-Muscle-Invasive Bladder Cancer: Just a Disturbing Sidelight?

Abstract

The EAU guidelines on non-muscle-invasive bladder cancer (NMIBC) provide for risk stratification in low, intermediate and high risk based on infiltration depth, grading, concomitant carcinoma in situ, recurrence status, focality and tumour size. The aim of this study was to evaluate guideline adherence regarding risk stratification and risk-adapted treatment recommendations in NMIBC. An email-based survey distributed over the urological professional associations of Berlin, Brandenburg, Bremen, Hamburg, Mecklenburg-Western-Pomerania, Lower Saxony and Schleswig-Holstein assessed field of activity (doctor's office vs. clinic) and the presence of the additional qualification "Medical Tumour Therapy" (aqMtt). Also it inquired about the tools used for risk stratification in NMIBC. Finally, 3 scenarios were given, 2 of them corresponding to high-risk NMIBC and one corresponding to intermediate-risk NMIBC. Respondents were asked to provide a treatment recommendation. The results were presented comparatively for field of activity (doctor's office vs. clinic) and presence of aqMtt. 74 responses were received (response rate of 12.3%). 57 (77.0%) of respondents had aqMtt. 52 (70.3%) worked in doctor's offices or medical care centres, 12 (16.2%) in a urology clinic, and for 10 (13.5%) respondents this information was lacking. The most frequently used tool for risk stratification was the EAU guideline. Accordingly, treatment recommendations for the three scenarios were considered to be correct if according to EAU guideline. In high-risk NMIBC, an average 29.3% (19.3-37.5%) of adequate treatment recommendations were made depending on the comparison group. An average of 69.8% (62.5-77.2%) and 0.9% (0.0-3.9%) treatment recommendations would lead to under- or overtreatment, respectively. The corresponding values for intermediate-risk NMIBC were 56.8% (52.6-62.5%) for adequate treatment, 43.2% (37.5-47.4%) for undertreatment and 0.0% for overtreatment. Field of activity and the presence of aqMtt had no significant impact on the accuracy of treatment recommendations. The results of our survey provide strong evidence of poor guideline adherence with a consecutive risk for undertreatment of patients with NMIBC. This requires joint efforts of all those involved in the treatment of NMIBC to improve quality of care.