Quality of care (QoC) measures among patients with recurrent, papillary-only bacillus Calmette-Guérin (BCG)-experienced high-risk non-muscle invasive bladder cancer (HR-NMIBC).

Abstract

709 Background: QoC indicators, including those from the American Urologic Association Quality Registry (AQUA) and National Comprehensive Cancer Network (NCCN), have been developed to identify gaps in care for HR-NMIBC. HR-NMIBC carries high clinical and economic burden, and care often involves multiple interventions, including transurethral resection of bladder tumor (TURBT), routine cystoscopy, and intravesical therapy, which may impact quality of life. Although BCG is the recommended bladder-sparing therapy for HR-NMIBC, recurrence after treatment is common. This study described QoC measures following diagnosis among BCG-experienced patients with papillary-only HR-NMIBC with recurrence in the US. Methods: This retrospective cohort study included patients ≥65 years from the SEER-Medicare database (01/01/2007-12/31/2022) with HR-NMIBC (papillary carcinoma [stage T1 or high-grade Ta] without carcinoma in situ [Tis staging or diagnosis codes]) who were BCG-experienced (i.e., adequate induction; ≥5 instillations within 70 days) with recurrent disease, with recurrence defined as having BCG re-challenge, TURBT, biopsy, radical cystectomy, or treatment with other intravesical therapies, systemic chemotherapy, radiotherapy, or pembrolizumab any time after BCG discontinuation. A subgroup analysis was conducted among patients receiving subsequent treatment within 30 days of recurrence. QoC measures included monitoring, treatment, and health services-related indicators assessed from HR-NMIBC diagnosis to the earliest of 12 months, end of continuous enrollment, plan switch, death, or end of data. Results: Among 3,177 patients with HR-NMIBC who received BCG and had recurrence (overall), 166 patients received subsequent treatment within 30 days (subgroup). Mean age was 76 years, 78% were male, and 92% were White. For monitoring QoC measures, 42% (overall) and 41% (subgroup) did not have routine cystoscopy (every 3-4 months) after diagnosis. Repeat TURBT ≤6 weeks after initial TURBT occurred in 32% of the overall sample and 28% of the subgroup. For treatment QoC measures, 41% and 12% of the overall sample did not initiate BCG within 3 and 6 months of diagnosis, respectively; rates in the subgroup were 37% and 13%. For health-related services QoC measures, 21% (overall) and 18% (subgroup) had hospital readmissions ≤30 days after an initial hospitalization. Among patients with cystectomy, hospital readmission ≤3 months occurred in 32% (overall) and 28% (subgroup), while death ≤3 months after cystectomy was observed in 1% and 5%, respectively. Conclusions: QoC measures were not consistently achieved, suggesting persistent care gaps following diagnosis among patients with recurrent, papillary-only BCG-experienced HR-NMIBC, including those with subsequent treatment within 30 days of initial recurrence.