Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non–muscle-invasive Bladder Cancer

• Published in: European urology oncology
• Main Authors: Mariappan, Paramananthan, Johnston, Allan, Trail, Matthew, Hamid, Sami, Hollins, Graham, Dreyer, Barend A., Ramsey, Sara, Padovani, Luisa, Garau, Roberta, Enriquez, Julia Guerrero, Boden, Alasdair, Maresca, Gianluca, Simpson, Helen, Hasan, Rami, Sharpe, Claire, Thomas, Benjamin G., Chaudhry, Altaf H., Khan, Rehan S., Bhatt, Jaimin R., Ahmad, Imran, Nandwani, Ghulam M., Dimitropoulos, Konstantinos, Makaroff, Lydia, Shaw, Johnstone, Graham, Catriona, Hendry, David
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 30.01.2024
• Subjects: Bladder cancer; Evidence-based medicine; Guidelines; Non–muscle-invasive bladder cancer; Progression; Quality indicators; Quality performance indicator, Quality control; Recurrence; Transurethral resection of bladder tumour; Progression; Transurethral resection of bladder tumour; Non–muscle-invasive bladder cancer; Recurrence; Quality indicators; Quality performance indicator, Quality control; Bladder cancer; Evidence-based medicine; Guidelines
• ISSN: 2588-9311; 2588-9311
• DOI: 10.1016/j.euo.2024.01.012

From 2688 new non–muscle-invasive bladder cancer patients treated within the framework of Scotland’s novel quality performance indicator programme and followed up for 5 yr, we found that hospitals achieving targets for detrusor muscle sampling and single instillation of mitomycin C during and after initial transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression. These parameters should augment prognostic calculators. Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non–muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland’s National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance. To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC. QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres. QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC). The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed. Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6–9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4–24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73–0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59–0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45–0.84, p = 0.002 and HR 0.65, 95% CI = 0.49–0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control. Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients. Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non–muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.