Utilization of intravesical chemotherapy following TURBT: A pre-implementation analysis of American College of Surgeon Commission on Cancer GU quality measures

Abstract

Objective: To evaluate utilization trends of postoperative intravesical chemotherapy (IVC) following transurethral resection of bladder tumor (TURBT) in patients with low-grade Ta non-muscle invasive bladder cancer (NMIBC) prior to implementation of a new Commission on Cancer (CoC) quality measure, and to identify factors influencing adherence in order to refine strategies for improving compliance.

Methods: Patients aged 18 years and older who underwent TURBT (2018-2020) were identified from the National Cancer Database (NCDB). Only those with low-grade Ta urothelial carcinoma were included. Patients with high-grade disease, advanced-stage NMIBC, or variant histology were excluded. The primary outcome was postoperative IVC utilization. Clinical and demographic variables analyzed included age, sex, race/ethnicity, insurance, tumor size, comorbidities, facility type, and geographic region. A multivariable logistic regression identified predictors of adherence.

Results: Among 25,518 patients, 21.8% received IVC, increasing from 20.84% (2018) to 23.09% (2020) (P = 0.0024). Younger age, smaller tumors, non-Black/non-White race, treatment at integrated network cancer programs, urban residence, and lower income were associated with higher IVC use. Medicaid/Medicare coverage correlated with lower utilization.

Conclusions: Significant disparities exist in IVC adherence. Addressing sociodemographic barriers, improving institutional compliance, and overcoming implementation challenges are essential to optimizing patient outcomes. The CoC quality measure may improve adherence and standardize care delivery.

Keywords: Intravesical chemotherapy; Low-grade non-muscle invasive bladder cancer; Quality measure; Transurethral resection of bladder tumor.