Extent of Risk-Aligned Surveillance for Cancer Recurrence Among Patients With Early-Stage Bladder Cancer

Abstract

Key Points Question Do patients with early-stage bladder cancer undergo cancer surveillance that is aligned with their risk of cancer recurrence? Findings In this US national cohort study of patients with early-stage bladder cancer treated in 85 Department of Veterans Affairs facilities, surveillance was performed at a comparable frequency for low- and high-risk patients within 70 of 85 facilities, differing by less than 1 cystoscopy over 2 years. Across facilities, these findings were reflected in a moderately strong and significant correlation of cystoscopy frequencies for high- and low-risk patients. Meaning Risk-aligned surveillance for early-stage bladder cancer is not widely practiced, which should alert those who care for patients with bladder cancer as well as those who care for patients with other neoplasms for which risk-aligned surveillance is recommended.

The impact of frequent cystoscopy on surgical care and cancer outcomes among patients with low‐risk, non–muscle‐invasive bladder cancer

“…As previously described, 10 we used validated algorithms to identify 1279 patients who were newly diagnosed with low-risk (low grade Ta) urothelial carcinoma of the bladder between 2005 and 2011 from national VA data (see Supporting Methods). We then excluded 99 patients because of missing covariates (see Supporting Methods) and 138 patients because they died or left VA care during the first 2 years after diagnosis, during which we assessed the frequency of cystoscopic surveillance.…”

“…As previously described, 10 we used procedure codes (see Supporting Table 1) to enumerate the frequency of cystoscopic surveillance during the first 2 years after diagnosis. 11,12 The time period during which we assessed cystoscopic surveillance (the surveillance window) started with the diagnosis date (ascertained using validated algorithms 11 ) and ended 2 years after diagnosis or at the time of cystectomy, radiotherapy, or cancer recurrence, whichever occurred first.…”

A frame semantic overview of NLP-based information extraction for cancer-related EHR notes

“…Frame Elements References CANCER DIAGNOSIS NAME: cancer type [44], [45], [42], [46], [47], [48], [49], [50], [51] ANATOMICAL SITE: the location description of the finding (including primary and metastatic sites) [45], [52], [42], [53], [54], [55], [25], [27], [56], [57] HISTOLOGY: histological description (e.g. carcinoma) [44], [52], [58], [55], [53], [54], [4], [27], [59], [43], [57] GRADE: appearance of the cancerous cells, can be frame with further information (GRADING VALUE) [44], [52], [54], [4], [48], [27], [59], [60], [43], [61], [62] INVASION TYPE: the stage or level of invasion [52] TUMOR BLOCK: tissue cores removed from regions of interest in paraffinembedded tissues (e.g. 0.6 mm in diameter) [52] TISSUE BANK: identifiers about location of tissue samples within an institution [52...…”

“…0.6 mm in diameter) [52] TISSUE BANK: identifiers about location of tissue samples within an institution [52] STATUS: whether confirmed, suspected and there is no evidence of finding (e.g. probable, definite, without) [42], [57] RECURRENT STATUS: the value of recurrent status [42], [63], [57] TEMPORAL INFORMATION: refers to information about time (e.g., year, month, and date, 2007-08-04) [42], [57] SPECIMEN TYPE: the type of specimen involved in diagnosis [53] LATERALITY: describes the side of a paired organ associated with origin of the primary cancer [53], [54], [25], [48], [64], [27], [51] TUMOR SIZE: how large across the tumor is at its widest point (part of cancer staging) [52], [53], [54], [25], [48], [65], [59], [60], [62], [57] TNM STAGE: cancer staging system, can be a separate frame with further information (TNM CLASSIFICATION) [55], [53], [2], [3], [25], [66], [67], [60], [50], [40], [61] EXTENSION: direct extension of tumor [53] UNCERTAINTY: used to differentiate clinical suspicions from conclusive findings (e.g., possible, likely) [68],…”

“…NEGATION: existence/negation of diagnosis (e.g., no, positive) [68], [57] DISEASE: disease related concepts related to diagnosis (disease stage and severity) [11], [25] DISEASE EXTENT: determine extent of disease (e.g., non-invasive, invasive, or metastatic) [68], [69], [57] STAGE: the overall stage of cancer (e.g. Stage 0, Stage I) [70], [52], [42], [54], [25], [69], [40], [43], [61], [57] EXISTENCE: existence description of the finding [45] TEMPORAL MODIFIER: temporal modifiers of the finding [45] ASSOCIATION: associations with other findings (may or may not be related to cancer) (e.g. causal, differential interpretation, and co-occurring) [45] BREAST CANCER DIAGNOSIS STATUS OF CANCER TYPES: presence or absence of various types of breast cancer (e.g.…”