Low adherence to recommended use of neoadjuvant chemotherapy for muscle-invasive bladder cancer
BlaZIB Study Group
(2023) World Journal of Urology, volume 41, issue 7, pp. 1837 - 1845
(Article)
Abstract
Purpose: To evaluate guideline adherence and variation in the recommended use of neoadjuvant chemotherapy (NAC) and the effects of this variation on survival in patients with non-metastatic muscle-invasive bladder cancer (MIBC). Patients and methods: In this nationwide, Netherlands Cancer Registry-based study, we identified 1025 patients newly diagnosed with non-metastatic MIBC
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between November 2017 and November 2019 who underwent radical cystectomy. Patients with ECOG performance status 0–1 and creatinine clearance ≥ 50 mL/min/1.73 m2 were considered NAC-eligible. Interhospital variation was assessed using case-mix adjusted multilevel analysis. A Cox proportional hazards model was used to evaluate the association between hospital specific probability of using NAC and survival. All analyses were stratified by disease stage (cT2 versus cT3-4a). Results: In total, of 809 NAC-eligible patients, only 34% (n = 277) received NAC. Guideline adherence for NAC in cT2 was 26% versus 55% in cT3-4a disease. Interhospital variation was 7–57% and 31–62%, respectively. A higher hospital specific probability of NAC might be associated with a better survival, but results were not statistically significant (HRcT2 = 0.59, 95% CI 0.33–1.05 and HRcT3-4a = 0.71, 95% CI 0.25–2.04). Conclusion: Guideline adherence regarding NAC use is low and interhospital variation is large, especially for patients with cT2-disease. Although not significant, our data suggest that survival of patients diagnosed in hospitals more inclined to give NAC might be better. Further research is warranted to elucidate the underlying mechanism. As literature clearly shows the potential survival benefit of NAC in patients with cT3-4a disease, better guideline adherence might be pursued.
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Keywords: Bladder carcinoma, Guideline adherence, MIBC, Muscle-invasive bladder cancer, Neoadjuvant chemotherapy, Radical cystectomy, Variation in healthcare, Urology
ISSN: 0724-4983
Publisher: Springer Verlag
Note: Funding Information: The BlaZIB study is funded by the Dutch Cancer Society (KWF; IKNL 2015–7914). The funding agency had no further role in this study. Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry. The authors thank Dr. Maarten J. Bijlsma from the department of Research & Development, Clinical Data Science, for statistical advice. The members of the BlaZIB study group are: Katja K.H. Aben, PhD (PI, Netherlands Comprehensive Cancer Organisation); Lambertus A. Kiemeney, PhD, Prof (PI, Radboud University Medical Centre); J. Alfred Witjes, MD, PhD, Prof (PI, Radboud University Medical Centre); Lisa M.C. van Hoogstraten, MSc (project coordinator, Netherlands Comprehensive Cancer Organisation); Theodora M. Ripping, PhD (researcher, Netherlands Comprehensive Cancer Organisation); Joost L. Boormans, MD, PhD (Erasmus Medical Centre); Catharina A. Goossens-Laan, MD, PhD (Alrijne Hospital); Antoine G. van der Heijden, MD, PhD (Radboud University Medical Centre); Michiel S. van der Heijden, MD, PhD (Netherlands Cancer Institute); Sipke Helder (Patient association ‘Leven met blaas- of nierkanker’); Tom J.N. Hermans, MD, PhD (VieCuri Medical Centre); Maarten C.C.M. Hulshof, MD, PhD (Amsterdam University Medical Centres, location AMC); Anna M. Leliveld, MD, PhD (University Medical Centre Groningen); Geert J.L.H. van Leenders, MD, PhD, Prof (Erasmus Medical Centre); Richard P. Meijer, MD, PhD, FEBU (University Medical Centre Utrecht); Reindert J.A. van Moorselaar, MD, PhD, Prof (Amsterdam University Medical Centres, location VUmc); Sasja F. Mulder, MD, PhD (Radboud University Medical Centre); Juus L. Noteboom, MD, PhD (University Medical Centre Utrecht); Jorg R. Oddens, MD, PhD (Amsterdam University Medical Centres, location AMC); Theo M. de Reijke, MD, PhD (Amsterdam University Medical Centres, location University of Amsterdam, department of Urology); Bas W.G. van Rhijn, MD, PhD, FEBU (Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital); Joep G.H. van Roermund, MD, PhD (Maastricht University Medical Centre); Tineke J. Smilde, MD, PhD (Jeroen Bosch Hospital); Guus W.J. Venderbosch (Patient association ‘Leven met blaas- of nierkanker’); Bart P. Wijsman, MD, PhD (Elisabeth-TweeSteden Ziekenhuis) Publisher Copyright: © 2023, The Author(s).
(Peer reviewed)
