Quality of care in patients with bladder cancer

Chamie, Karim; Saigal, Christopher S.; Lai, Julie; Hanley, Jan M.; Setodji, Claude Messan; Konety, Badrinath R.; Litwin, Mark S.

doi:10.1002/cncr.26402

Cited by 68 publications

(55 citation statements)

References 32 publications

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“…observed significant variation in adherence to recommended perioperative processes of care for patients with NIMBC, including the adequacy of clinical and pathologic staging and use of treatment and surveillance strategies. 17, 18 The appropriate use of immediate intravesical chemotherapy has specifically been proposed as a quality measure of NMIBC treatment, as it has been shown to decrease intravesical recurrences. 15 These important studies highlight the need for adherence to guideline-recommended perioperative processes, but do not specifically assess the quality of TURBT or compensate for an incomplete surgery.…”

Section: Discussionmentioning

confidence: 99%

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

et al. 2016

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Purpose Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor (TURBT), likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of TURBT using a surgical checklist. Materials and Methods We formed a multi-institutional group of urologists with expertise in bladder cancer and identified 10 critical items that should be performed during every high-quality TURBT. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of TURBTs performed before and after implementation. Results from all institutions were combined using a meta-analysis to estimate the overall change in the mean number of items documented. Results The operative notes for 325 TURBTs during checklist use were compared to 428 TURBTs performed prior to checklist implementation. Checklist use increased the mean number of items reported from 4.8 to 8.0 per TURBT, resulting in a mean increase of 3.3 (95% CI 1.9, 4.7) items on meta-analysis. The percentage of reports that included all 10 items increased from 0.5% to 27% (p<0.0001) with the checklist. Surgeons who reported more checklist items tended to have a slightly higher proportion of biopsies containing muscle, though not at conventional significance (p=0.062). Conclusions The use of a 10-item checklist during TURBT improved reporting of critical procedural elements. Although there was no clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.

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Section: Discussionmentioning

confidence: 99%

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

et al. 2016

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“…Non-muscle-invasive bladder cancer was selected due to excellent CSS and a similar follow-up pattern that includes urologist office visits and abdominal imaging. Bladder cancer controls (BCC) were selected using an algorithm established by Chamie et al 16 This cohort included individuals aged 66 years with lowgrade (grade 1 or 2), non-muscle-invasive bladder cancer (CS Ta, T1, and Tis) that did not undergo cystectomy. Patients with a prior ESRD diagnosis were excluded.…”

Section: Control Groupsmentioning

confidence: 99%

Overall survival advantage with partial nephrectomy: A bias of observational data?

Shuch¹,

Hanley

Lai

et al. 2013

Cancer

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the Urologic Diseases in America ProjectBACKGROUND: Partial nephrectomy (PN) and radical nephrectomy (RN) are standard treatments for a small renal mass. Retrospective studies suggest an overall survival (OS) advantage, however a randomized phase 3 trial suggests otherwise. The effects of both surgical modalities on OS were evaluated compared with controls. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. Individuals treated with PN or RN for localized renal cell carcinoma (RCC) measuring 4 cm were compared with 2 control groups (non-muscle-invasive bladder cancer (BCC) and noncancer controls (NCC). Using a greedy algorithm, RCC groups were matched with controls by demographics and comorbidities. OS for surgical groups and controls were compared. The cause of death was evaluated for cancer groups when differences in OS were noted. RESULTS: Patients undergoing PN and RN were matched with controls. All cancer groups had >95% 10-year cancer-specific survival (CSS). Median OS was similar between RN (9.05 years) and BCC (8.67 years; P 5.067) and NCC (8.77 years; P 5.49). Median OS was improved for PN (10.45 years) compared with BCC (8.75 years; P<.001) and NCC controls (8.76 years; P<.001). A multivariate Cox hazards model demonstrated that PN improved OS compared with NCC (hazard ratio, 1.257; P<.001) and BCC (hazard ratio, 1.364; P<.001). CONCLUSIONS: RN patients had similar OS compared with controls, suggesting that this treatment modality does not compromise survival. Patients undergoing PN had improved OS compared with controls, suggesting possible selection bias. The apparent survival advantage conferred by PN in SEER-Medicare case series is likely the result of selection bias involving unmeasured confounders.

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“…Despite established best-practice guidelines, widespread adoption of effective measures has lagged [2,3]. In a prior study examining claims from 4,514 patients with high-risk, non–muscle-invasive bladder cancer, we found that only 1 patient received all elements of recommended treatment, despite a process-outcome link [4,5]. The improved survival following more frequent surveillance and instillation of intravesical therapy is partly attributable to the nature of the disease—recurrence is seen in nearly three-fourths of the patients, and disease progression is seen in a significant number [6].…”

Section: Introductionmentioning

confidence: 99%

Treatment and survival in patients with recurrent high-risk non–muscle-invasive bladder cancer

Chamie¹,

Ballon-Landa

Daskivich³

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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Background Multiple recurrences develop in patients with high-risk non–muscle-invasive bladder cancer. As neither the association of recurrences with survival nor the subsequent aggressive treatment in individuals with recurrent high-grade non–muscle-invasive bladder cancer has ever been quantified, we sought to determine whether the increasing number of recurrences is associated with higher subsequent treatment and mortality rates. Methods Using linked Surveillance, Epidemiology, and End Results–Medicare data, we identified subjects with recurrent high-grade, non–muscle-invasive disease diagnosed in 1992 to 2002 and followed up until 2007. Using competing-risks regression analyses, we quantified the incidence of radical cystectomy, radiotherapy, and systemic chemotherapy after each recurrence. We then performed a propensity-score adjusted competing-risks regression analysis to determine whether the increasing recurrences portend worse survival. Results Of 4,521 subjects, 2,694 (59.6%) had multiple recurrences within 2 years of diagnosis. Compared with patients who only had 1 recurrence, those with ≥4 recurrences were less likely to undergo radical cystectomy (hazard ratio [HR] = 0.73, 95% CI: 0.58–0.92), yet more likely to undergo radiotherapy (HR = 1.51, 95% CI: 1.23–1.85) and systemic chemotherapy (HR = 1.58, 95% CI: 1.15–2.18). For patients with ≥4 recurrences, only 25% were treated with curative intent. The 10-year cancer-specific mortality rates were 6.9%, 9.7%, 13.7%, and 15.7% for those with 1, 2, 3, and ≥4 recurrences, respectively. Conclusions Only 25% of patients with high-risk non–muscle-invasive bladder cancer who experienced recurrences at least 4 times underwent radical cystectomy or radiotherapy. Despite portending worse outcomes, increasing recurrences do not necessarily translate into higher treatment rates.

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Quality of care in patients with bladder cancer

Cited by 68 publications

References 32 publications

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

Overall survival advantage with partial nephrectomy: A bias of observational data?

Treatment and survival in patients with recurrent high-risk non–muscle-invasive bladder cancer

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