National and international guidelines call for administration of postoperative immediate chemotherapy to reduce recurrence of non-muscle invasive bladder cancer. Yet this is done in less than half of cases. A new study led by Clint Cary, M.D., MPH, of the Regenstrief Institute and Indiana University School of Medicine, explores environmental barriers to implementation of these guidelines and may help refine strategies to improve care of bladder cancer patients.
In the study, published in The Journal of Urology, the most significant environmental barrier to chemotherapy was identified by 58 Michigan urologists in diverse practice settings as lack of a protocol or standard operating procedure in the recovery room for instilling and disposing of the chemotherapy.
“Our findings are encouraging because the number one barrier to administering post-op chemo to reduce bladder cancer recurrence was an operational barrier — one that is modifiable and can be relatively easily tackled. Protocols or standard operating procedures can be established and professionals will follow them,” said Dr. Cary. “By not routinely administering post-op chemo we simply are not following the evidence-based data that exists, and which informs guidelines and can help us reduce cancer recurrences.”
More than 81,000 new cases of bladder cancer were diagnosed in the United States in 2020. Approximately three-quarters of these cases were non-muscle invasive bladder cancer. Whether postoperative immediate chemotherapy is indicated is governed by clinical factors including tumor stage and grade, as well number of tumors present in the bladder. Chemotherapy is appropriate in the majority of cases.
“Current recurrence rate of non-muscle invasive bladder cancer is estimated to be as high as 75 percent. So it’s important that we know what the barriers to administering post-op chemo are and develop tailored strategies to lower them, so recurrence decreases,” said Dr. Cary. “It’s critical that we maximize evidenced-based care for patients with bladder cancer.”
In addition to Dr. Cary, authors of “Ranking Important Factors for Using Postoperative Chemotherapy in Non-muscle Invasive Bladder Cancer: Conjoint analysis results from the Michigan Urological Surgery Improvement Collaborative (MUSIC)” are Michael Weiner, M.D., MPH of Regenstrief Institute and IU School of Medicine; Susan Linsell, MHSA; Khurshid Ghani, MBChB, M.S. and David C. Miller, M.D., MPH of the University of Michigan; Yan Tong, PhD, M.S.; Michael O. Koch, M.D.; Susan M. Perkins, PhD; and Gregory Zimet, PhD, all of IU School of Medicine.
The study was supported by National Cancer Institute grant K23CA212272.
Dr. Cary is extending this line of research and is currently conducting a nationwide study on barriers for chemotherapy guideline adherence with the goal of finding real-world solutions for quality improvement and ultimately fewer bladder cancer recurrences.
About Clint Cary, M.D., MPH
In addition to his role as a research scientist at Regenstrief Institute, Clint Cary, M.D., MPH, is an associate professor of urology at Indiana University School of Medicine.
About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.
About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.
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