Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State.

Published on Oct 1, 2019in Urology1.924
· DOI :10.1016/J.UROLOGY.2019.06.021
Conrad M. Tobert13
Estimated H-index: 13
(UIHC: University of Iowa Hospitals and Clinics),
Kenneth G. Nepple22
Estimated H-index: 22
(UI: University of Iowa)
+ 5 AuthorsBradley A. Erickson27
Estimated H-index: 27
(UIHC: University of Iowa Hospitals and Clinics)
ABSTRACT OBJECTIVE To identify factors associated with nonmuscle invasive bladder cancer (NMIBC) American Urological Association (AUA) guideline compliance in a rural state, to evaluate compliance rates over time, and to assess the impact of patient and provider rurality on delivery of NMIBC care. METHODS We identified 847 Iowans in Surveillance, Epidemiology, and End Results-Medicare from 1992 to 2009 with high-grade NMIBC who survived 2 years and were not treated with cystectomy or radiation during this period. Compliance with AUA guidelines was assessed over time and compared to patient demographic, tumor, and treatment institution variables. Impact of rurality was analyzed using Surveillance, Epidemiology, and End Results ZIP code data travel distance of patient to nearest urologist practice location. RESULTS Overall compliance with AUA guidelines was low ( 30 miles) but distance did not affect compliance with other measures. Compliance was not associated with cancer-specific survival. CONCLUSION Compliance with post-Transurethral Resection of Bladder Tumor (TURBT) NMIBC treatment guidelines has improved but remains suboptimal in our rural state, and is highly associated with treatment at an academic cancer center for reasons that could not be fully explained with these data.
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