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Consistencies in Follow-up After Radical Cystectomy for Bladder Cancer: A Framework Based on Expert Practices Collaboratively Developed by the European Association of Urology Bladder Cancer Guideline Panels
LS. Mertens, HM. Bruins, R. Contieri, M. Babjuk, BP. Rai, AC. Puig, JLD. Escrig, P. Gontero, AG. van der Heijden, F. Liedberg, A. Martini, A. Masson-Lecomte, RP. Meijer, H. Mostafid, Y. Neuzillet, B. Pradere, J. Redlef, BWG. van Rhijn, M....
Language English Country Netherlands
Document type Journal Article, Multicenter Study
- MeSH
- Cystectomy * methods MeSH
- Humans MeSH
- Urinary Bladder Neoplasms * surgery pathology MeSH
- Aftercare standards methods MeSH
- Follow-Up Studies MeSH
- Surveys and Questionnaires MeSH
- Practice Guidelines as Topic MeSH
- Urology standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe MeSH
BACKGROUND AND OBJECTIVE: There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion. METHODS: We surveyed 27 urologist members of the EAU guideline panels for non-muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as >75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis. KEY FINDINGS AND LIMITATIONS: We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC. CONCLUSIONS AND CLINICAL IMPLICATIONS: This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies. PATIENT SUMMARY: We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.
Department of Oncological Urology University Medical Center Utrecht Utrecht The Netherlands
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Bichat Claude Bernard Hospital AP HP Université Paris Cité Paris France
Department of Urology Caritas St Josef Medical Centre University of Regensburg Regensburg Germany
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Hospital Universitari Vall d'Hebron Barcelona Spain
Department of Urology Inselspital University Hospital Bern Bern Switzerland
Department of Urology Instituto Valenciano de Oncologia Valencia Spain
Department of Urology La Croix du Sud Hospital Quint Fonsegrives France
Department of Urology MD Anderson Cancer Center Houston TX USA
Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology Radboud University Medical Center Nijmegen The Netherlands
Department of Urology Royal Surrey Hospital Guildford UK
Department of Urology Saint Louis Hospital AP HP Paris Cité University Paris France
Department of Urology Skane University Hospital Malmö Sweden
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Department of Urology Zuyderland Medical Center Sittard Heerlen The Netherlands
Division of Urology Department of Special Surgery University of Jordan Amman Jordan
Edinburgh Bladder Cancer Surgery University of Edinburgh Western General Hospital Edinburgh UK
Institute of Translational Medicine Lund University Malmö Sweden
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Patient Representative European Association of Urology Guidelines Office Arnhem The Netherlands
References provided by Crossref.org
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- $a BACKGROUND AND OBJECTIVE: There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion. METHODS: We surveyed 27 urologist members of the EAU guideline panels for non-muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as >75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis. KEY FINDINGS AND LIMITATIONS: We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC. CONCLUSIONS AND CLINICAL IMPLICATIONS: This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies. PATIENT SUMMARY: We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.
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