Factors affecting guideline adherence in the initial treatment of non-muscle invasive bladder cancer: Retrospective study in a French peripheral hospital

To assess whether the initial treatment of non-muscle invasive bladder cancer (NMIBC) was performed according to the guidelines, and to determine the reasons why initial treatment was not provided in nonadherence cases. We retrospectively reviewed all patients with NMIBC who underwent their first transurethral resection of bladder tumor (TURBT) at a peripheral hospital, between 2007 and 2016. The treatment offered to the patient was compared to the European Association of Urology guidelines according to risk stratification. For each patient who did not receive the treatment according to the guidelines, one of the following reasons was identified: poor patient compliance, poor patient general health status, urologist's decision, lack of resources. One hundred fifty-nine patients were included with a mean age of 72.2 years at the time of NMIBC diagnosis. The low-risk patients were strictly treated according to the guidelines. Among the intermediate-risk patients, 14% received mitomycin C. Among the high-risk patients, 39% received intravesical Bacillus Calmette-Guerin. In the nonadherence cases (61%), the reasons were related to the patient in 44% of cases (poor compliance, 21%; poor patient general health status, 23%), urologist's decision in 54% of cases, and lack of resources in 2% of cases. Thirty-seven percent of the high-risk patients underwent re-resection. Overall, adherence to NMIBC guidelines was low in all treatment types (intravesical therapy, re-resection, or cystectomy for very high-risk patients), but this finding was similar to that in previous studies. Reasons were mainly related to the urologist's decision or to the patient condition (poor compliance or poor general health status). 3. Objectif Évaluer si le traitement initial des tumeurs de vessie non infiltrant le muscle (TVNIM) était conforme aux recommandations des sociétés savantes et lorsque le traitement ne l’était pas, d’en évaluer les causes. L’ensemble des dossiers de TVNIM reséquée pour la 1re fois dans un centre hospitalier régional périphérique français, entre 2007 et 2016, ont été revus rétrospectivement. Le traitement reçu a été comparé aux référentiels européens. Pour chaque patient qui ne recevait pas le traitement conformément au référentiel, un des motifs suivants était identifié : mauvaise compliance, terrain défavorable, décision de l’urologue ou manque de ressources. Au final, 159 patients ont été inclus avec un âge moyen de 72,2 ans au diagnostic. Tous les patients à f