Presentation Authors: Joseph M Caputo*, George Moran, New York, NY, Alison Keller, Bronx, NY, Gen Li, Christopher B Anderson, New York, NY
Introduction: Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Affairs (VA) health system. Our objective was to describe the quality of care for Veterans with newly diagnosed NMIBC within Veterans Integrated Service Network (VISN) 2.
Methods: ICD-9/10 codes were used to identify patients in VISN 2 with newly-diagnosed bladder cancer from 1/2016-8/2017. We collected data on diagnostic transurethral resection of bladder tumor (TURBT), and induction and maintenance intravesical therapies (IVT). We assigned NMIBC-risk groups according to the AUA guidelines and used operative notes to estimate tumor size and focality. Our primary objectives were percentage of TURBTs that contained muscle, the use of upper tract imaging at diagnosis, high-risk NMIBC treated with induction IVT, and the use of maintenance IVT when indicated. We performed logistic regression to test if distance to diagnosing VA was associated with receipt of induction IVT.
Results: We identified 140 newly diagnosed patients (Table 1). 79% received appropriate upper tract imaging. 86% had NMIBC of whom 16% were low-risk, 28% intermediate-risk, and 56% high-risk. Detrusor was present in the initial TURBT in 80% (97/121) of all NMIBC patients and 84% (57/68) of high-risk patients. Repeat TURBT was performed in 62% (32/52) of patients with any T1 disease and 56% (38/68) of high-risk disease. Induction IVT was given to 0% of low-risk, 24% of intermediate-risk, and 66% of high-risk patients. 7 patient charts were not accessible to review maintenance IVT. In the accessible charts, 59% (24/41) of high-risk patients responded to induction BCG and 54% (13) of them were placed on maintenance BCG. On logistic regression, distance to VA was not associated with receipt of induction IVT (OR=0.99, 95% CI 0.97-1.01, p=0.52) after adjusting for age and comorbidities.
Conclusions: Among Veterans with newly-diagnosed NMIBC in VISN 2, we found detrusor muscle was sampled in the majority of initial TURBTs and observed high utilization of repeat TURBT in T1 NMIBC. Induction IVT was used primarily in high-risk disease and maintenance IVT was given at a relatively similar rate. Further investigation is needed to improve receipt of IVT among VISN 2 patients.