MP60-12 MULTI-INSTITUTIONAL QUALITY CARE INITIATIVE TO IMPROVE THE CARE OF PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER (2014)

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2014MP60-12 MULTI-INSTITUTIONAL QUALITY CARE INITIATIVE TO IMPROVE THE CARE OF PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER Bernard Bochner, Dahlia Sperling, Andrew Feifer, Joseph Mashni, Dean Bajorin, Guido Dalbagni, Harry Herr, Sherri M. Donat, Matthew Milowsky, Jay Shah, Ashish Kamat, H. Barton Grossman, Robert Grubb, Stephen Brandes, Arnold Bullock, Seth Strope, Bruce Roth, Adam Kibel, Louis Weigand, Gary Steinberg, Walter Stadler, Natali Rutiaga, Mark Schoenberg, Trinity Bivalacqua, Charlene Rogers, Peter Black, Alan So, Martin Gleave, Wassim Kassouf, Bassel Bachir, Faysal Yafi, Seth Lerner, Guilherme Godoy, Gilead Amiel, Alexandre Zlotta, Neil Fleshner, Michael Jewett, Girish Kulkarni, Srikala Sridhar, Ian Tanock, Anthony Joshua, Peter Bostrom, Cynthia Kuk, and Yair Lotan Bernard BochnerBernard Bochner More articles by this author , Dahlia SperlingDahlia Sperling More articles by this author , Andrew FeiferAndrew Feifer More articles by this author , Joseph MashniJoseph Mashni More articles by this author , Dean BajorinDean Bajorin More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Harry HerrHarry Herr More articles by this author , Sherri M. DonatSherri M. Donat More articles by this author , Matthew MilowskyMatthew Milowsky More articles by this author , Jay ShahJay Shah More articles by this author , Ashish KamatAshish Kamat More articles by this author , H. Barton GrossmanH. Barton Grossman More articles by this author , Robert GrubbRobert Grubb More articles by this author , Stephen BrandesStephen Brandes More articles by this author , Arnold BullockArnold Bullock More articles by this author , Seth StropeSeth Strope More articles by this author , Bruce RothBruce Roth More articles by this author , Adam KibelAdam Kibel More articles by this author , Louis WeigandLouis Weigand More articles by this author , Gary SteinbergGary Steinberg More articles by this author , Walter StadlerWalter Stadler More articles by this author , Natali RutiagaNatali Rutiaga More articles by this author , Mark SchoenbergMark Schoenberg More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , Charlene RogersCharlene Rogers More articles by this author , Peter BlackPeter Black More articles by this author , Alan SoAlan So More articles by this author , Martin GleaveMartin Gleave More articles by this author , Wassim KassoufWassim Kassouf More articles by this author , Bassel BachirBassel Bachir More articles by this author , Faysal YafiFaysal Yafi More articles by this author , Seth LernerSeth Lerner More articles by this author , Guilherme GodoyGuilherme Godoy More articles by this author , Gilead AmielGilead Amiel More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Michael JewettMichael Jewett More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Srikala SridharSrikala Sridhar More articles by this author , Ian TanockIan Tanock More articles by this author , Anthony JoshuaAnthony Joshua More articles by this author , Peter BostromPeter Bostrom More articles by this author , Cynthia KukCynthia Kuk More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1766AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Level 1 evidence supports a survival benefit for patients with muscle invasive bladder cancer (BlCa) that receive perioperative cisplatin chemotherapy (Ctx) in addition to radical cystectomy (RC). Underutilization of multimodal therapy has been reported nationally. We instituted a prospective, multicenter Quality Care Initiative (QCI) to improve the use of periop Ctx. Methods A two phase effort was initiated at 16 academic institutions. Phase 1 was initiated in 2010 and designed to evaluate baseline patterns of periop Ctx use for T2-4N0M0 BlCa pts that underwent RC between 2003-2008. Phase 2 was a prospective QCI. Data on all eligible pts were collected prospectively for 12 months on a web-based survey system. Both surgeons and medical oncologists participated to determine treatments received and rationale for treatment decisions. The quality indicators included: 1) referral to medical oncology for consideration of multimodality therapy, 2) if recommended, perioperative Ctx be cisplatin based and at least 3 cycles, 3) perform a bilateral pelvic lymph node dissection (BPLND), and 4) all treatment be completed within 6 months. Results All 16 centers participated in phase 1. Of 4344 pts on whom data was available, 34% received periop Ctx. Neoadjuvant and adjuvant use was 14% and 20%, respectively. 65% of pts receiving Ctx were treated with a cisplatin-based regimen. 95 % of patients received BPLND. 10 institutions completed 12 months of data collection for the QCI. Over 700 pts that underwent RC were evaluated. 388 pts with T2-4N0M0 disease were deemed eligible for data entry. 56% of eligible pts received periop Ctx, 47% received neoadjuvant Ctx and 9% received adjuvant Ctx. This represented a 64.7% increase in the use of any periop Ctx and a 3.4 fold increase in neoadjuvant Ctx compared to baseline data. Again 95% of patients received BPLND, with at least 72% of those yielding 12 or more lymph nodes. Conclusions We have successfully completed a multi-institutional prospective QCI to improve the use of periop Ctx in pts undergoing RC for resectable, non-metastatic bladder cancer. Our data demonstrates that significant improvements can be achieved in not only overall use of periop Ctx but most notably in the use of neoadjuvant Ctx. As a result of this study, granular data will be forthcoming explaining differences in practice patterns. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e637 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Bernard Bochner More articles by this author Dahlia Sperling More articles by this author Andrew Feifer More articles by this author Joseph Mashni More articles by this author Dean Bajorin More articles by this author Guido Dalbagni More articles by this author Harry Herr More articles by this author Sherri M. Donat More articles by this author Matthew Milowsky More articles by this author Jay Shah More articles by this author Ashish Kamat More articles by this author H. Barton Grossman More articles by this author Robert Grubb More articles by this author Stephen Brandes More articles by this author Arnold Bullock More articles by this author Seth Strope More articles by this author Bruce Roth More articles by this author Adam Kibel More articles by this author Louis Weigand More articles by this author Gary Steinberg More articles by this author Walter Stadler More articles by this author Natali Rutiaga More articles by this author Mark Schoenberg More articles by this author Trinity Bivalacqua More articles by this author Charlene Rogers More articles by this author Peter Black More articles by this author Alan So More articles by this author Martin Gleave More articles by this author Wassim Kassouf More articles by this author Bassel Bachir More articles by this author Faysal Yafi More articles by this author Seth Lerner More articles by this author Guilherme Godoy More articles by this author Gilead Amiel More articles by this author Alexandre Zlotta More articles by this author Neil Fleshner More articles by this author Michael Jewett More articles by this author Girish Kulkarni More articles by this author Srikala Sridhar More articles by this author Ian Tanock More articles by this author Anthony Joshua More articles by this author Peter Bostrom More articles by this author Cynthia Kuk More articles by this author Yair Lotan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...