Study: Immediate Intravesical Chemotherapy Underused

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ATLANTA—Immediate intravesical chemotherapy (IVC) is underused in bladder cancer patients, according to a presentation at the American Urological Association 2012 annual meeting.

David C. Miller, MD, MPH, and fellow members of the Urological Surgery Quality Collaborative (USQC) implemented a project to better understand and improve the IVC use following endoscopic treatment in bladder cancer patients. The USQC comprises seven practices.

From September 2010 to October 2011, the investigators collected clinical and baseline IVC utilization data for patients undergoing bladder biopsy at the five USQC sites. From June to October 2011, treating surgeons also began to document reasons why patients were not administered with immediate IVC.

Among 1,638 patients with applicable data, 609 (37.2%) were considered by the investigators to be ideal candidates for immediate IVC, but it was administered to only 36.5% of those patients.

Ideal candidates in terms of adherence to current clinical guidelines were patients with one or two clinical stage Ta/T1 papillary tumors that were completely resected. Good evidence exists showing that IVC can delay or prevent recurrent tumors in these patients, said Dr. Miller, Assistant Professor of Urology at the University of Michigan in Ann Arbor. “The challenge is that it appears to be used very infrequently,” he told attendees.

Researchers observed a significant variation in IVC use across practice sites for both ideal (26%-49%) and non-ideal (10%-23%) cases.

In cases in which immediate IVC was not administered, the researchers asked if the reason was appropriate or potentially modifiable due to either educational reasons or logistical factors, like the medication not being available, Dr. Miller said. Educational deficits and logistical factors require fundamentally different solutions, he added.

“Educational reasons are best addressed by having a better understanding or acceptance of the literature, whereas logistical factors might be asking your pharmacist why mitomycin C is not available at the hospital or not even having a pharmacy at the surgery center where you're doing the resection.”

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