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

K. Hendricksen, A. Aziz, P. Bes, FK. Chun, J. Dobruch, LA. Kluth, P. Gontero, A. Necchi, AP. Noon, BWG. van Rhijn, M. Rink, F. Roghmann, M. Rouprêt, R. Seiler, SF. Shariat, B. Qvick, M. Babjuk, E. Xylinas, Young Academic Urologists Urothelial...

. 2019 ; 5 (4) : 681-688. [pub] 20171023

Language English Country Netherlands

Document type Comparative Study, Journal Article, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc20028883

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.

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$a Hendricksen, Kees $u Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: k.hendricksen@nki.nl.
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$a Discrepancy Between European Association of Urology Guidelines and Daily Practice in the Management of Non-muscle-invasive Bladder Cancer: Results of a European Survey / $c K. Hendricksen, A. Aziz, P. Bes, FK. Chun, J. Dobruch, LA. Kluth, P. Gontero, A. Necchi, AP. Noon, BWG. van Rhijn, M. Rink, F. Roghmann, M. Rouprêt, R. Seiler, SF. Shariat, B. Qvick, M. Babjuk, E. Xylinas, Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology,
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$a 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.
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$a Aziz, Atiqullah $u Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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$a Bes, Perrine $u Ipsen Pharma, Boulogne-Billancourt, France.
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$a Chun, Felix K-H $u Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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$a Dobruch, Jakub $u Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland.
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$a Kluth, Luis A $u Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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$a Gontero, Paolo $u Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Torino, Italy.
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$a Necchi, Andrea $u Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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$a Noon, Aidan P $u Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
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$a van Rhijn, Bas W G $u Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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$a Rink, Michael $u Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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$a Roghmann, Florian $u Department of Urology, Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany.
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$a Rouprêt, Morgan $u Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France.
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$a Seiler, Roland $u Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, University of Bern, Bern, Switzerland.
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$a Shariat, Shahrokh F $u Department of Urology, Medical University of Vienna, Vienna, Austria.
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$a Qvick, Brian $u Ipsen Pharma, Boulogne-Billancourt, France.
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$a Babjuk, Marek $u Department of Urology, 2nd Faculty of Medicine, Charles University in Praha Motol University, Praha, Czech Republic.
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$a Xylinas, Evanguelos $u Department of Urology, Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.
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