‘Overuse’ of Surveillance Testing Observed in Low-Grade Non-Muscle Invasive Bladder Cancer

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A large study showed an increase in surveillance testing over time among patients with low-grade papillary stage Ta non-muscle invasive bladder cancer (NMIBC).

The study also revealed a 60% increase in the cost of care during the first year after diagnosis. These findings were published in JAMA Network Open.

“Bladder cancer has the highest lifetime treatment cost of all cancers, with substantial economic burden throughout the entire disease course,” the researchers wrote. “Efforts to improve adherence to current practice guidelines, with the focus on limiting overuse of surveillance testing and treatment, may mitigate associated increasing costs of care.”


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For this study, the researchers examined surveillance and treatment patterns in patients who were diagnosed with low-grade Ta tumors and included in the SEER-linked Medicare database from 2004 to 2013. The researchers also reviewed Medicare claims data through 2014.

The cohort included 13,054 patients with low-grade Ta NMIBC. The median age was 76 years (range, 71-81 years), and 73.5% of patients were men. The median follow-up was 84.8 months.

Rates of cystoscopy increased over time, from 79.3% in 2004 to 81.5% in 2013 (P =.007). Patients received a median of 3 cystoscopies per year after diagnosis.

Use of CT or MRI for upper tract imaging also increased, from 30.4% in 2004 to 47.0% in 2013 (P <.001). Patients received a median of 2 scans per year.

The use of urine-based testing increased as well, from 44.8% in 2004 to 54.9% in 2013 (P <.001). Patients had a median of 2 to 3 urine-based tests per year.

In multivariable analyses, female sex was associated with more frequent cryptoscopic evaluation, cytologic testing, and upper tract imaging.

As for treatment, 17.2% of patients received intravesical bacillus Calmette-Guérin, 6.1% received intravesical chemotherapy, and 89.7% underwent at least 1 subsequent transurethral resection of the bladder tumor.

Overall, 1.7% of patients experienced disease recurrence, and 0.4% experienced progression.

The total median cost of care at 1 year after diagnosis increased by 60% over the study period, from $34,792 in 2004 to $53,986 in 2013.

“As we strive to improve bladder cancer care and health care spending, it will be important that clinicians be thoughtful about tests and procedures being performed,” the researchers wrote. “Goals might include delivery of risk-aligned surveillance that comprises more frequent surveillance of patients with high risk of disease progression and death as well as de-escalation of surveillance among patients with low risk of worse cancer outcomes.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Bree KK, Shan Y, Hensley PJ, et al. Management, surveillance patterns, and costs associated with low-grade papillary stage Ta non-muscle-invasive bladder cancer among older adults, 2004-2013. JAMA Netw Open. Published online March 18, 2022. doi:10.1001/jamanetworkopen.2022.3050



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