Practice patterns of high-risk non-muscle invasive bladder cancer (HR-NMIBC) in real-world Canadian practice.

e16594 Background: There is a paucity of evidence pertaining to real-world treatment of localized bladder cancer, particularly in Canada. We sought to investigate real-world treatment patterns in HR-NMIBC patients, treated in Alberta to understand current treatment practices, predictors of BCG utilization and real-world survival outcomes. Methods: We conducted a retrospective, observational cohort study of de novo HR-NMIBC patients diagnosed between 2010-2022 using population-level administrative databases in Alberta. Data sources included Alberta Cancer Registry (ACR), Vital Statistics, Pharmaceutical Information Network (PIN), Health Practitioner Claims, Discharge Abstract Database (DAD) and National Ambulatory Care Report System (NACRS) databases. HR-NMIBC was defined as AJCC stage N0 and M0 with either Tis, T1, or high-grade Ta (HG-Ta). Patients were followed from diagnosis to last known contact with healthcare system, end of 2021, or death. Multivariable logistic regression analysis was used to identify features associated with receipt of BCG. Results: In this cohort, 3874 HR-NMIBC patients were identified: 82% were male and mean age was 71 years. Tumor stage was T1 in 50%, HG-Ta in 33% and Tis in 17%. Following TURBT, 60.8% of the cohort received no intravesical therapy while 35.6% received BCG treatment, 2.9% intravesical gemcitabine, and 0.6% mitomycin C. Patients who received BCG were predominantly male (83.9%), had T1 tumors (52%) and had a CCI of 0-1 (83.5%). Few (<10%) patients underwent cystectomy. In patients who received BCG, 28.3% completed only one dose 56.9% completed five induction doses, and 32% received “adequate” dosing (≥5 induction doses + ≥2 maintenance doses). In multivariable regression analysis, the strongest predictor of receipt of BCG was high-grade disease (OR 1.62; 95% CI: 1.25-2.10; p < 0.001). Other features associated with higher BCG utilization were younger age, fewer comorbidities, and rural residence and being diagnosed closer to 2010. Overall survival was 10.3 years (95% CI: 116-131 years). Conclusions: In this large, population-based retrospective study, we identify relatively poor utilization of BCG among patients with HR-NMIBC with 32% of patients receiving adequate BCG therapy, per FDA definitions. These data, while concordant with other jurisdictions, do not address underlying causes which may relate to BCG supply issues, patient preference, or fitness to receive therapy, or physician beliefs regarding treatment efficacy. Additional research is needed to identify strategies to improve utilization of guideline recommended therapy among HR-NMIBC patients in real-world settings.