National and international guidelines call for administration of postoperative immediate chemotherapy to reduce recurrence of non-muscle invasive bladder cancer. Yet this is done in less than half of cases. A new study led by Clint Cary, MD, MPH, of the Regenstrief Institute and Indiana University School of Medicine, explores environmental barriers to implementation of these guidelines and may help refine strategies to improve care of bladder cancer patients.

In the study, published in The Journal of Urology, the most significant environmental barrier to chemotherapy was identified by 58 Michigan urologists in diverse practice settings as lack of a protocol or standard operating procedure in the recovery room for instilling and disposing of the chemotherapy.

"Our findings are encouraging because the number one barrier to administering post-op chemo to reduce bladder cancer recurrence was an operational barrier—one that is modifiable and can be relatively easily tackled. Protocols or standard operating procedures can be established and professionals will follow them," said Dr. Cary. "By not routinely administering post-op chemo we simply are not following the evidence-based data that exists, and which informs guidelines and can help us reduce cancer recurrences."

More than 81,000 new cases of bladder cancer were diagnosed in the United States in 2020. Approximately three-quarters of these cases were non-muscle invasive bladder cancer. Whether postoperative immediate chemotherapy is indicated is governed by clinical factors including tumor stage and grade, as well number of tumors present in the bladder. Chemotherapy is appropriate in the majority of cases.

"Current recurrence rate of non-muscle invasive bladder cancer is estimated to be as high as 75%. So it's important that we know what the barriers to administering post-op chemo are and develop tailored strategies to lower them, so recurrence decreases," said Dr. Cary. "It's critical that we maximize evidenced-based care for patients with bladder cancer."

Dr. Cary is extending this line of research and is currently conducting a nationwide study on barriers for chemotherapy guideline adherence with the goal of finding real-world solutions for quality improvement and ultimately fewer bladder cancer recurrences.