Adherence to surveillance guidelines after radical cystectomy: a population-based analysis

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Radical cystectomy is a standard treatment for bladder cancer, necessitating post-operative surveillance.
• National Comprehensive Cancer Network (NCCN) guidelines recommend specific surveillance protocols to detect recurrence and complications.
• Adherence to these guidelines is crucial for optimal patient outcomes.

Purpose of the Study:

• To evaluate adherence to NCCN surveillance guidelines after radical cystectomy in a large population-based cohort.
• To identify patient and provider factors associated with adherence to surveillance protocols.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results-Medicare database (2000-2007).
• Included patients aged ≥66 with nonmetastatic bladder cancer undergoing radical cystectomy.
• Defined adherence based on receipt of urine cytology and imaging (chest, abdomen, pelvis) within 2 years post-surgery.

Main Results:

• Overall adherence to all recommended surveillance tests was low (17% in year 1 and 17% in year 2).
• Only 9% of patients had complete surveillance in both years.
• Lower adherence was associated with advanced pathologic stage and unmarried status; higher adherence was linked to high-volume surgeons and seeing a medical oncologist.

Conclusions:

• Surveillance practices after radical cystectomy frequently deviate from NCCN guidelines.
• Omission of urine cytology is a significant factor contributing to low adherence.
• Improving adherence, particularly through high-volume surgeons, presents a key opportunity for enhancing bladder cancer care quality.