368 Single Shot Instillation Intra-Vesical Chemotherapy Administration: A Global Audit of Guideline Compliance – Results From the BURST-RESECT Study

Aim Auditing administration of Single instillation intra-vesical chemotherapy (SI-IVC) which has level 1 evidence in reducing cancer recurrence rate after Trans-Urethral Resection (TURBT) for non-muscle invasive bladder cancer (NMIBC). Method Using RESECT study (NCT05154084) data, a retrospective observational study was performed. Patients included underwent primary curative TURBT for bladder cancer. Cases were excluded if SI-IVC administration data was missing. The primary outcome was the rate of administration of SI-IVC. Results Data from 232 hospitals globally were included. After exclusions, there were 7933 (87.5%) cases analysed (44% low grade, 56% high grade NMIBC). SI-IVC was administered in 3075 (39%) of cases (Low grade + SI-IVC: 48%, high grade + SI-IVC: 32%). Considering low grade cases (3390), where SI-IVC is most beneficial, reasons listed for non-administration were “Surgeon did not request it” (68%), “Surgeon requested it, but it was not given” (7%) and “SI-IVC is never given at our hospital” (25%). Of 3566 cases where the surgeon did not request SI-IVC, 1497 (42%) the surgeon thought it was not indicated, 512 (14.4%) were because of potential contra-indications, no reason documented in 1210 (34%). Of these 2707 cases with no documented contraindication, 837 (31%) had low grade disease and likely would have benefitted. Conclusions The most common reason for non-administration of guideline recommended SI-IVC was that the surgeon did not request it, in almost one third of these cases the patient is likely to have benefitted. The RESECT study will test whether providing feedback and education to surgeons about their guideline compliance can improve compliance and outcomes.