Non-muscle invasive bladder cancer: Are epicrises the 'Bermuda Triangle' of information transfer?

The aim of the study was to collect information regarding the quality of communication of risk-determining factors or risk profile, and the guideline conformity of recommendations for adjuvant treatment in patients with non-muscle invasive bladder cancer (NMIBC) between clinical and ambulatory urologists.

At three German urological clinics during the period between 2012-2014, epicrises of 1,033 NMIBC-patients were retrospectively summarised to 505 tumour episodes (tumour resection including any re-resections) and analysed regarding the endpoints 1) risk profile is explicitly named or recorded risk factors are sufficient for the determination of risk profile, and 2) guideline conformity of treatment recommendation. Independent factors influencing the endpoints were determined by means of multivariate logistic regression models.

The risk profile was explicitly named for 3.6% of tumour episodes; for 68.9% a risk profile could be derived from the information in the epicrises. Treatment recommendations were given for 93.7% of tumour episodes, but only 17.8% were guideline compliant. 42.6% of the recommendations were not reliably effective; 33.1% and 0.2% resulted in under- and overtreatment respectively. Neither endpoint showed gender specific or regional differences, but both were considerably less likely to be achieved in case of recurrence.

The discrepancy between treatment recommendation (93.7%) and guideline compliance (17.8%) could indicate a lack of familiarity with guidelines. The quality of the epicrises of NMIBC-patients was poor and bore the potential risk of undertreatment. The results of this study are not necessarily applicable to other clinics, but could, however, prompt physicians to re-examine epicrises for the fulfillment of the quality criteria examined here.