Predictors of Compliance with Muscle Invasive Bladder Cancer Quality Measures and its Effect on Survival Outcomes

To assess and improve quality of care, the Commission on Cancer developed 3 evidence-based quality measures for the treatment of muscle invasive bladder cancer. We sought to assess performance of these measures prior to their implementation, whether compliance was associated with survival and whether patient factors influenced compliance.

We assessed all patients 18 to 90 years old diagnosed with invasive, nonmetastatic bladder cancer between 2004 and 2015 using the National Cancer Database. Both univariable and multivariable analyses were utilized to determine the effect of compliance on survival and identify patient level predictors of compliance.

Of the 46,502 patients identified 22,218 underwent surgical management and 5,282 received trimodal therapy. All quality measures were achieved in 45.7% of the surgical cohort, which was associated with lower all cause mortality (HR 0.89, 95% CI 0.85-0.93, p <0.01). Time less than 90 days to trimodal therapy was achieved in 35.0% and was not associated with lower all cause mortality (HR 0.93, 95% CI 0.85-1.01, p=0.07). In the surgical cohort compliance was associated with higher income (OR 1.27, 95% CI 1.13-1.46, p <0.01), living in a higher educated zip code area (OR 1.15, 95% CI 1.02-1.30, p=0.02) and living 10 or more miles from the place of treatment (OR 1.38, 95% CI 1.29-1.47, p <0.01).

Quality measure compliance is associated with improved survival in patients undergoing surgical management of muscle invasive bladder cancer. Despite this benefit, achievement of all 3 metrics was observed in less than half of patients prior to quality measure implementation.