Do clinical practice guidelines (CPGs) change clinical practice? An analysis of CPG impact on referral and treatment patterns for neoadjuvant chemotherapy in bladder cancer

5077 Background: Neoadjuvant chemotherapy (CT) for muscle invasive urothelial BC improves survival and is considered standard of care. In Alberta, Canada, CPGs recommending CT were developed with input from the wider urologic community and disseminated in May 2005. To evaluate the effect of CPG on practice patterns, a review of referral and treatment patterns before and after CPG implementation was undertaken. Methods: All patients in the Calgary Health Region who underwent radical cystectomy for BC from a 5 year period encompassing the CPG release date were identified. Two cohorts (A: 2.5 to 0.5 years prior to CPG, B: 0.5 to 2.5 years post CPG) were defined. Charts were reviewed to identify patients who were eligible for CT based upon the diagnosis of clinical stage 2 or 3 urothelial BC. Rates of referral to medical oncology and actual treatment with CT were ascertained for each cohort. Logistic regression analysis was undertaken to identify variables impacting referral and treatment decisions. Results: 141 patients were identified. Of these, 67 (Cohort A: 32; Cohort B: 35) were eligible for CT by CPG criteria. The referral rates for cohorts A and B were 2 (6.3%) and 11 (31%) respectively (OR 6.88, p=0.018, 95% CI 1.34, 34.04) In cohort A no referred patients were offered CT. In cohort B, 9 patients (25%) were offered treatment and 6 (17%) received CT. In subgroup analysis there was a significant correlation between referral rate, female sex and pathologic stage 3 or 4 disease. Conclusions: Referral and treatment rates for CT have improved significantly after release of CPGs in Alberta, but are still low. Of patients who are referred to medical oncology in this jurisdiction the majority (82%) are offered treatment, indicating that the most significant limitation to provision of standard of care treatment is at the level of referral. While CPGs have positively impacted referral rates, it remains clear that the majority of BC patients are ultimately not accessing comprehensive cancer care. Further work should focus on both improving methods of effectively disseminating CPGs and on novel tools for increasing the uptake of evidence based practice. No significant financial relationships to disclose.