Adjuvant Intravesical Chemotherapy Still Underused

SAN DIEGO—Perioperative intravesical chemotherapy (IVC) following transurethral resection of bladder tumors (TURBT) continues to be underused, according to data presented at the American Urological Association (AUA) annual meeting.

In a study of 1,782 patients who underwent TURBT, Casey Kowalik, MD, and colleagues at Lahey Hospital & Medical Center in Burlington, Mass., found that only 36 (2%) received concurrent IVC. A single perioperative dose of IVC following TURBT has been shown to decreased recurrence risk and is recommended by the AUA and the European Association Urology. A previous study of nationwide claims data from 1997 to 2004 found that only 0.33% of patients received same day IVC after TURBT.

Dr. Kowalik's group used Current Procedural Terminology codes to identify TURBT patients in the American College of Surgeons National Surgical Quality Improvement Program database, which is a national prospective outcomes-based database designed to measure surgical quality of care. The patients had a median age of 73 years; 74% of patients were male. The investigators ascertained that 668 tumors (37%) were small, 650 (36%) were medium-sized, and 464 (26%) were large.

The researchers observed no difference in average operative times and average length of stay among patients receiving perioperative IVC. The IVC group had no reported perioperative complications.

Study limitations include the absence of data related to the timing of IVC after TURBT, specific tumor characteristics, and prior TURBT procedures. Furthermore, IVC may have been administered and not billed, the authors noted.

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