Intravesical chemotherapy use after radical nephroureterectomy: A national survey of urologic oncologists - Urologic Oncology: Seminars and Original Investigations (abstract)
Highlights
- •The use of intravesical agents after RNU remains low despite good scientific evidence.
- •Reasons underlying relative underutilization are multifactorial.
- •Dissemination of evidence is necessary to increase use following RNU.
Abstract
To
determine the use of prophylactic intravesical chemotherapy (pIVC)
following radical nephroureterectomy (RNU) and barriers to utilization
in a survey study of urologic oncologists.
Methods
A
survey instrument was constructed, which queried respondents on
professional experience, practice environment, pIVC use, and reasons for
not recommending pIVC when applicable. The survey was electronically
distributed to members of the Society of Urologic Oncology over an
8-week period. Survey software was used for analysis.
Results
The
survey response rate was 22% (158 of 722). Half of the respondents were
in practice for ≤10 years, while 90% performed ≤10 RNU cases annually.
Of the 144 urologists regularly performing RNU, only 51% reported
administering pIVC, including 22 exclusively in patients with a prior
history of bladder cancer. One-third administered pIVC intraoperatively,
whereas the remainder instilled pIVC at ≤3 (7%), 4 to 7 (37%), 8 to 14
(20%), and>14 (3%) days postoperatively. Almost all urologists noted
giving a single instillation of pIVC. Agents included mitomycin-C (88%),
thiotepa (7%), doxorubicin (3%), epirubicin (1%), and BCG (1%). Among
respondents who did not administer pIVC, the most common reasons cited
included lack of data supporting use (44%), personal preference (19%),
and office infrastructure (17%).
Conclusion
Only
51% of urologic oncologists report using pIVC in patients undergoing
RNU. Reasons underlying this underutilization are multifactorial,
thereby underscoring the need for continued dissemination of existing
data and additional studies to support its benefits. Moreover, improving
the logistics of pIVC administration may help to increase utilization
rates.
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