Enhanced Quality and Effectiveness of Transurethral Resection of Bladder Tumour in Non–muscle-invasive Bladder Cancer: A Multicentre Real-world Experience from Scotland’s Quality Performance Indicators Programme

Mariappan, Paramananthan; Johnston, Allan; Padovani, Luisa; Clark, Eilidh; Trail, Matthew; Haddad, Sami; Hollins, Graham; Simpson, Helen; Thomas, Benjamin G.; Hasan, Rami; Bhatt, Jaimin R.; Ahmad, Imran; Nandwani, G.M.; Mitchell, I.V.; Hendry, David

doi:10.1016/j.eururo.2020.06.051

Cited by 47 publications

(44 citation statements)

References 28 publications

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“…This can act as a prompt for staff to anticipate SI‐IVC. Similarly, Appendix 5 shows a proforma used for TURBTs, with similar versions being used in all Scottish sites [32], where the patient eligibility for SI‐IVC and the surgeon’s decision to give SI‐IVC or not (i.e. through contraindications such as bladder perforation) is clearly documented, again providing a reminder.…”

Section: Resultsmentioning

confidence: 99%

“…A SI‐IVC reduces recurrences in selected patients with NMIBC in clinical trials [8,10] and ‘real‐world’ data [32]. Adherence to this high‐certainty evidence and strong guideline recommendation facilitates optimal patient care as an adjunct to high‐quality TURBT.…”

Section: Discussionmentioning

confidence: 99%

“…No formal negative sanctions were levied against underperforming sites, but participants did not like being seen to be underperforming, nor preparing plans to address poor performance, particularly in one site where the bladder cancer lead was sceptical if targets could ever be met with their department’s current set up. The Scottish QPIs can be regarded as an audit and feedback intervention, which can increase performance [34], and this has had a positive effect [32], through citing a robust evidence base, utilising a wide set of metrics (not only SI‐IVC), engaging stakeholders, communicating clear targets, embedding the process within national governance whilst encouraging local responsibility, which are all highlighted as good performance target practices by the Health Foundation [35]. However, without having controlled this process in a randomised implementation trial or controlled before and after or interrupted time series studies (notwithstanding likely Hawthorne effects), it is difficult to comment on effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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What influences adherence to guidance for postoperative instillation of intravesical chemotherapy to patients with bladder cancer?

Dunsmore¹,

Duncan

Mariappan

et al. 2021

BJU International

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To understand the barriers and facilitators to single instillation of intravesical chemotherapy (SI-IVC) use after resection of non-muscle-invasive bladder cancer (NMIBC) in Scotland and England using a behavioural theory-informed approach. Subjects and MethodsIn a cross-sectional descriptive study of practices at seven hospitals, we investigated care pathways, policies, and interviewed 30 urology staff responsible for SI-IVC. We used the Theoretical Domains Framework (TDF) to organise our investigation and conducted deductive thematic analyses, while inductively coding emergent beliefs. ResultsBarriers to SI-IVC were present at different organisational levels and professional roles. In four hospitals, there was a policy to not instil SI-IVC in theatre. Six hospitals' staff reported delays in mitomycin C (MMC) ordering and/or local storage. Lack of training, skills and perceived workload affected motivation. Facilitators included access to modern instilling devices (four hospitals) and incorporating reminders in operation proforma (four hospitals). Performance targets (with audit and feedback) within a national governance framework were present in Scotland but not England. Differences in coordinated leadership, sharing best practices, and disliking being perceived as underperforming, were evident in Scotland. ConclusionsHigh-certainty evidence shows that SI-IVC, such as MMC, after NMIBC resection reduces recurrences. This evidence underpins international guidance. The number of eligible patients receiving SI-IVC is variable indicating suboptimal practice. Improving SI-IVC adherence requires modifications to theatre instilling policies, delivery and storage of MMC, staff training, and documentation. Centralising care, with bladder cancer expert leadership and best practices sharing with performance targets, likely led to improvements in Scotland. National quality improvement, incorporating audit and feedback, with additional implementation strategies targeted to professional role could improve adherence and patient outcomes elsewhere. This process should be controlled to clarify implementation intervention effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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What influences adherence to guidance for postoperative instillation of intravesical chemotherapy to patients with bladder cancer?

Dunsmore¹,

Duncan

Mariappan

et al. 2021

BJU International

Self Cite

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“…Bladder cancer (BLCA) is the ninth most common cancer worldwide [7]. According to the degree of in ltration, bladder cancer can be divided into non-muscular invasive bladder cancer and muscular invasive bladder cancer [8].…”

Section: Discussionmentioning

confidence: 99%

TCGA data mining suggested that high GSDMB expression in bladder cancer indicated an excellent prognosis

Xu¹,

Tang²,

Zhang³

2020

Preprint

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Background. Researchers have demonstrated that GSDMB is highly expressed in cancer tissues and located in amplicons, genomic regions that are often amplified during cancer development. We evaluated the role of GSDMB in bladder cancer using publicly available data.Methods. The relationship between clinical correlation features and GSDMB were analyzed with the Wilcoxon rank sum test (2 groups), Kruskal-Wallis test (multiple groups) and logistic regression. Clinicopathologic characteristics associated with overall survival in TCGA patients using Cox regression and the Kaplan-Meier method. Gene Set Enrichment Analysis (GSEA) was performed using TCGA data set. Results. GSDMB was differentially expressed between the tumor group and the normal group and was highly expressed in the tumor group. Reduced GSDMB expression in BLCA as significantly associated with grade (OR = 4.55, High Grade vs. Low Grade), clinical stage (OR = 2.34, Ⅱvs. Ⅳ), status (OR = 0.51 survival vs. death), all p-values <0.05. Kaplan-Meier survival analysis showed that BLCA with GSDMB- low had a worse prognosis than that with GSDMB-high (p = 0.001). The univariate analysis revealed that GSDMB- low correlated significantly with a poor overall survival (OS) (HR: 0.93; 95%CI: 0.89-0,98; p = 0.006). The multivariate analysis revealed that GSDMB remained independently associated with overall survival, with a HR of 0.711 (CI: 0.55-0.92; p = 0.009). GSEA show that focal adhesion, pathways in cancer, small cell lung cancer, renal cell carcinoma, bladder cancer and other cancer related pathways are differentially enriched in GSDMB low expression phenotype. Conclusions. High GSDMB mRNA expression is an independent risk factor for excellent prognosis in bladder cancer.

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“…In 2008, to address the need for cancer care improvement, the Scottish government started Scotland’s Quality Performance Indicator (QPI) programme. According to its recent report, recurrence risk at first follow-up cystoscopy in low-risk NMIBCa and the probability of residual disease in high-risk NMIBCa have dropped by 12% and 4%, respectively, through the years 2014–2017 [ 18 ]. Despite these improvements, patients with NMIBCa face many years of repeated cystoscopies and subsequent surgeries, imaging, and associated bother.…”

Section: Evidence Synthesismentioning

confidence: 99%

Bladder Cancer: Current Challenges and Future Directions

2021

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Bladder cancer (BCa) is the most common malignancy of the urinary tract and one of the most prevalent cancers worldwide. While the clinical approach to BCa has remained largely unchanged for many years, recent discoveries have paved the way to a new era of diagnosis and management of the disease. BCa-specific mortality started to decrease in the regions with a wide range of activities leading to greater social awareness of the risk factors and the decline in carcinogenic exposure. The urologic community refines the role of transurethral surgery towards more rigorous and high-quality techniques. New agents have been approved for patients with BCG failure who faced radical cystectomy so far. Although radical removal of the bladder is the gold standard for muscle invasive cancer management, the extent and clinical value of lymphadenectomy is currently heavily challenged in randomized trials. Furthermore, alternatives to perioperative chemotherapy have arisen to increase the likelihood of complete treatment delivery and successful oncological outcomes. Finally, improvements in molecular biology and our understanding of tumorigenesis open the era of personalized medicine in bladder cancer. In the present review, the status and future directions in bladder cancer epidemiology, diagnosis and management are thoroughly discussed.

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Enhanced Quality and Effectiveness of Transurethral Resection of Bladder Tumour in Non–muscle-invasive Bladder Cancer: A Multicentre Real-world Experience from Scotland’s Quality Performance Indicators Programme

Cited by 47 publications

References 28 publications

What influences adherence to guidance for postoperative instillation of intravesical chemotherapy to patients with bladder cancer?

What influences adherence to guidance for postoperative instillation of intravesical chemotherapy to patients with bladder cancer?

TCGA data mining suggested that high GSDMB expression in bladder cancer indicated an excellent prognosis

Bladder Cancer: Current Challenges and Future Directions

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