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Clinical Practice Guidelines Underused in Bladder Cancer

Low guideline compliance prevails at provider-level for patients with high-grade bladder cancer

MONDAY, July 11 (HealthDay News) -- Clinical practice guidelines for management of patients with bladder cancer are not being followed, with provider-level factors contributing to this underuse, according to a study published online July 11 in Cancer.

Karim Chamie, M.D., from the University of California in Los Angeles, and colleagues characterized practice patterns in patients with high-grade non-muscle-invasive bladder cancer in relation to recognized guidelines. A total of 4,545 Medicare subjects diagnosed with high-grade non-muscle-invasive bladder cancer between 1992 and 2002, who survived for at least two years without undergoing definitive treatment, were included in the analysis. The association of patient, sociodemographic, tumor, and provider characteristics with the compliance measures was investigated.

The investigators found that only one case received all the recommended measures. During the first two years after diagnosis, approximately 42 percent of the physicians did not perform at least one cytology, one cystoscopy, and one instillation of immunotherapy for any patient nested within their practice. Radiographic imaging (odds ratio [OR], 1.19) and instillation of immunotherapy (OR, 1.67) increased significantly after 1997. A contributing factor to the low compliance rate was surgeon-level variation for individual guideline measures (cystoscopy, cytology, perioperative intravesical chemotherapy, and intravesical immunotherapy).

"There is a marked underuse of care in patients with high-grade non-muscle-invasive bladder cancer; in the current study, we found a single case of comprehensive compliance in 4,545 eligible patients," the authors write.

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