Discrepancy Between European Association of Urology Guidelines and Daily Practice in the Management of Non-muscle-invasive Bladder Cancer: Results of a European Survey

TY - JOUR

T1 - Discrepancy Between European Association of Urology Guidelines and Daily Practice in the Management of Non-muscle-invasive Bladder Cancer: Results of a European Survey

AU - Hendricksen, Kees

AU - Aziz, Atiqullah

AU - Bes, Perrine

AU - Chun, Felix K-H

AU - Dobruch, Jakub

AU - Kluth, Luis A

AU - Gontero, Paolo

AU - Necchi, Andrea

AU - Noon, Aidan P

AU - van Rhijn, Bas W G

AU - Rink, Michael

AU - Roghmann, Florian

AU - Rouprêt, Morgan

AU - Seiler, Roland

AU - Shariat, Shahrokh F

AU - Qvick, Brian

AU - Babjuk, Marek

AU - Xylinas, Evanguelos

AU - Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology

N1 - Copyright © 2017. Published by Elsevier B.V.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: The European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guidelines are meant to help minimise morbidity and improve the care of patients with NMIBC. However, there may be underuse of guideline-recommended care in this potentially curable cohort.OBJECTIVE: To assess European physicians' current practice in the management of NMIBC and evaluate its concordance with the EAU 2013 guidelines.DESIGN, SETTING, AND PARTICIPANTS: Initial 45-min telephone interviews were conducted with 20 urologists to develop a 26-item questionnaire for a 30-min online quantitative interview. A total of 498 physicians with predefined experience in treatment of NMIBC patients, from nine European countries, completed the online interviews.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics of absolute numbers and percentages of the use of diagnostic tools, risk group stratification, treatment options chosen, and follow-up regimens were used.RESULTS AND LIMITATIONS: Guidelines are used by ≥87% of physicians, with the EAU guidelines being the most used ones (71-100%). Cystoscopy (60-97%) and ultrasonography (42-95%) are the most used diagnostic techniques. Using EAU risk classification, 40-69% and 88-100% of physicians correctly identify all the prognostic factors for low- and high-risk tumours, respectively. Re-transurethral resection of the bladder tumour (re-TURB) is performed in 25-75% of low-risk and 55-98% of high-risk patients. Between 21% and 88% of patients received a single instillation of chemotherapy within 24h after TURB. Adjuvant intravesical treatment is not given to 6-62%, 2-33%, and 1-20% of the patients with low-, intermediate-, and high-risk NMIBC, respectively. Patients with low-risk NMIBC are likely to be overmonitored and those with high-risk NMIBC undermonitored. Our study is limited by the possible recall bias of the selected physicians.CONCLUSIONS: Although most European physicians claim to apply the EAU guidelines, adherence to them is low in daily practice.PATIENT SUMMARY: Our survey among European physicians investigated discrepancies between guidelines and daily practice in the management of non-muscle-invasive bladder cancer (NMIBC). We conclude that the use of the recommended diagnostic tools, risk-stratification of NMIBC, and performance of re-TURB have been adopted, but adjuvant intravesical treatment and follow-up are not uniformly applied.

AB - BACKGROUND: The European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guidelines are meant to help minimise morbidity and improve the care of patients with NMIBC. However, there may be underuse of guideline-recommended care in this potentially curable cohort.OBJECTIVE: To assess European physicians' current practice in the management of NMIBC and evaluate its concordance with the EAU 2013 guidelines.DESIGN, SETTING, AND PARTICIPANTS: Initial 45-min telephone interviews were conducted with 20 urologists to develop a 26-item questionnaire for a 30-min online quantitative interview. A total of 498 physicians with predefined experience in treatment of NMIBC patients, from nine European countries, completed the online interviews.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics of absolute numbers and percentages of the use of diagnostic tools, risk group stratification, treatment options chosen, and follow-up regimens were used.RESULTS AND LIMITATIONS: Guidelines are used by ≥87% of physicians, with the EAU guidelines being the most used ones (71-100%). Cystoscopy (60-97%) and ultrasonography (42-95%) are the most used diagnostic techniques. Using EAU risk classification, 40-69% and 88-100% of physicians correctly identify all the prognostic factors for low- and high-risk tumours, respectively. Re-transurethral resection of the bladder tumour (re-TURB) is performed in 25-75% of low-risk and 55-98% of high-risk patients. Between 21% and 88% of patients received a single instillation of chemotherapy within 24h after TURB. Adjuvant intravesical treatment is not given to 6-62%, 2-33%, and 1-20% of the patients with low-, intermediate-, and high-risk NMIBC, respectively. Patients with low-risk NMIBC are likely to be overmonitored and those with high-risk NMIBC undermonitored. Our study is limited by the possible recall bias of the selected physicians.CONCLUSIONS: Although most European physicians claim to apply the EAU guidelines, adherence to them is low in daily practice.PATIENT SUMMARY: Our survey among European physicians investigated discrepancies between guidelines and daily practice in the management of non-muscle-invasive bladder cancer (NMIBC). We conclude that the use of the recommended diagnostic tools, risk-stratification of NMIBC, and performance of re-TURB have been adopted, but adjuvant intravesical treatment and follow-up are not uniformly applied.

KW - Journal Article

U2 - 10.1016/j.euf.2017.09.002

DO - 10.1016/j.euf.2017.09.002

M3 - SCORING: Journal article

C2 - 29074050

VL - 5

SP - 681

EP - 688

JO - EUR UROL FOCUS

JF - EUR UROL FOCUS

SN - 2405-4569

IS - 4

ER -