Understanding the Barriers to Neoadjuvant Chemotherapy in Patients with Muscle Invasive Bladder Cancer: A Quality Improvement Initiative. Issue 2 (14th March 2021)

• Record Type: Journal Article
• Authors: Andino, Juan J.; Sessine, Michael; Singhal, Udit; Reichert, Zachery R.; Wray, Daniel; Shafer, Christine; Moore, Marissa; Weizer, Alon Z.; Kaffenberger, Samuel D.; Herrel, Lindsey A.; Morgan, Todd M.; Hafez, Khaled Z.; Montgomery, Jeffrey S.
• Is Part Of: Urology practice. Volume 8:Issue 2(2021)
• Page Start: 217
• Page End: 225
• Publication Date: 2021-03-14
• Subjects: neoadjuvant therapy -- quality improvement -- urinary bladder neoplasms
• DOI: 10.1097/UPJ.0000000000000200
• Languages: English
• ISSNs: 2352-0779

Abstract

Abstract: Introduction: Utilization of neoadjuvant chemotherapy for the management of muscle invasive bladder cancer remains low. We sought to understand our practice of neoadjuvant chemotherapy use in order to design a quality improvement initiative geared toward optimizing medical oncology referral. Methods: We identified 339 patients with ≥cT2 bladder cancer treated with radical cystectomy between 2012 and 2017 at our institution. We assessed the rate of referral to medical oncology, rate of neoadjuvant chemotherapy administration and medical, patient and provider variables associated with neoadjuvant chemotherapy use. Bayesian logistic regression modeling identified variables associated with neoadjuvant chemotherapy use, and chart review provided granular patient-level data. Results: Of the patients 85% (289) were referred to medical oncology and 62.5% (12) received neoadjuvant chemotherapy. Renal insufficiency, hearing loss and treating urologist were conclusively associated with lower odds of neoadjuvant chemotherapy use. A total of 46 patients were not referred to medical oncology, and 50% of these patients had medical contraindications to cisplatin cited as the reason for no referral. A total of 38 patients met with medical oncology but did not receive neoadjuvant chemotherapy. A total of 30 patients (79%) had comorbidities that impacted this decision, with 15 (39%) ineligible based on impaired renal function. Conclusions: Despite the relatively high rates of medical oncology referral and neoadjuvant chemotherapy use in this cohort, there are still opportunities to improve the efficiency of this practice. Quality improvement initiatives could optimize the referral of patients with ≥T2 bladder cancer for consideration of cisplatin based neoadjuvant chemotherapy and establish an important quality metric in the management of these patients.