Bladder Cancer Surveillance Not Aligned With Risk: Study of VA Facilities
Patients at VA facilities with high-risk early-stage bladder cancer tend to have cystoscopic surveillance at frequencies similar to those with low-risk disease.
A retrospective cohort study showed that most Veterans Affairs (VA) facilities perform cystoscopic surveillance at similar frequencies for patients with low-risk or high-risk early-stage bladder cancer during the 2 years after diagnosis.1This finding is in contrast with current cancer care guideline, which recommend aligning surveillance frequency with cancer risk. (In other words, high-risk patients undergo surveillance more often than low-risk patients.) The study was published online September 28, 2018, in JAMA Network Open.
The study included 85 VA facilities that treat low-risk and high-risk patients. Eligible patients were those whom were diagnosed with low-risk or high-risk early-stage bladder cancer between 2005 and 2011. In total, 1278 low-risk and 2115 high-risk patients were included in the analysis. Nearly all patients were male (99%), and the median age was 77 years.
The mean adjusted frequency of surveillance cystoscopy for low-risk patients during the 2 years following diagnosis across all facilities was 4.8 years (range, 3.7-6.2); for high-risk patients, mean frequency of surveillance cystoscopy was 5.4 years (range, 4.6-6.0). Guidelines recommend frequency of surveillance cystoscopy for low-risk patients during 2 years after diagnosis to be no more than 3 cystoscopies; for high-risk patients, the maximum is 6 to 8.
The researchers found that most facilities (70 of 85) performed surveillance at similar frequencies for both risk groups, the difference being less than 1 cystoscopy procedure. Only 4 facilities showed a statistically significant difference in surveillance frequency between low-risk and high-risk patients.
“In conclusion, our study highlights that risk-aligned surveillance for early-stage bladder cancer is not widely practiced,” the study authors wrote. “On the contrary, patients with high- and low-risk cancer undergo surveillance at comparable frequency, despite recommendations that high-risk patients warrant surveillance at least twice as often.”
- Schroeck FR, Lynch KE, Chang JW, et al. Extent of risk-aligned surveillance for cancer recurrence among patients with early-stage bladder cancer[published September 28, 2018]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2018.3442