Guideline-recommended post-operative intravesical chemotherapy and cystoscopic surveillance among patients with low- and intermediate-risk non-muscle invasive bladder cancer

Introduction: We sought to characterize concordance of surveillance and treatment patterns in a large community-based healthcare system with the American Urologic Association/Society of Urologic Oncology (AUA/SUO) guideline for low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC). We expect the results of this study to improve the oncologic care of patients with NMIBC. Methods: This was a retrospective cohort study of patients aged 18 years or older diagnosed with low- or intermediate-risk NMIBC between 1/1/2018 and 12/31/2022 and followed until 12/31/2024. The prevalence of single-dose post-operative intravesical chemotherapy instillations, cystoscopy procedures, and urine cytology tests were used to determine at, below, and above guideline-concordance. Results: A total of 631 low-risk and 619 intermediate-risk NMIBC patients were identified. Prevalences of single-dose immediate postoperative intravesical chemotherapy were: 35.2% (low-risk) and 36.8% (intermediate-risk). In the low-risk NMIBC group, average guideline-concordance was 47.5% for cystoscopy and 82.3% for cytology. In the intermediate-risk group, average guideline-concordance was 54.1% for cystoscopy and 27.2% for cytology. Percent of cystoscopy procedures exceeding guideline-concordance was 30.5% and 14.5% in the low- and intermediate-risk NMIBC groups, respectively. Discussion: Although guideline-concordance of single-dose intravesical instillations, cystoscopy procedures, and cytology tests mirrored what is reported in the literature, the prevalence of cystoscopy and cytology tests exceeding guideline-concordance was notably less, which may be a feature of our integrated delivery and finance system. Conclusion: Understanding the current landscape of concordance with the AUA/SUO guideline is necessary for every healthcare delivery system to optimize the oncologic care of patients with NMIBC.