Quality of care (QoC) measures among patients with high-risk non–muscle-invasive bladder cancer (HR-NMIBC) who are unresponsive to bacillus Calmette-Guérin (BCG) treatment: A SEER-Medicare analysis.

575 Background: HR-NMIBC is associated with a high disease burden and risk of recurrence. Its management requires multiple interventions (e.g., transurethral resection of bladder tumor [TURBT]), surveillance cystoscopy, BCG instillations, cystectomy) that may impact patient lives. Several QoC measures in NMIBC from the National Comprehensive Cancer Network and American Urologic Association Quality (AQUA) registry exist with the goal of improving patient outcomes; however, real-world data on the topic are scarce, particularly among BCG-unresponsive patients. This retrospective cohort study evaluated QoC measures in real-world for patients with BCG-unresponsive HR-NMIBC with either carcinoma in situ (CIS) or papillary carcinoma (PAP). Methods: SEER-Medicare Data (01/01/2007–12/31/2020) were used to identify patients aged ≥65 years with an HR-NMIBC diagnosis (index date) who were unresponsive to BCG (i.e., received a next treatment within 365 days after adequate BCG induction [≥5 instillations within 70 days] and maintenance [≥2 instillations within 180 days]). The CIS cohort included patients with a stage Tis tumor or CIS-related diagnosis code, while the PAP cohort included those with a stage T1 or high-grade Ta tumor. Monitoring-, treatment-, and health services-related QoC measures were assessed from index date to the earliest of 12 months, end of continuous enrollment, enrollment plan switch, death, or end of data availability. Results: Among BCG-unresponsive patients with HR-NMIBC, 193 were in the CIS cohort (mean age: 74 years, 81% male, 93% White) and 108 were in the PAP cohort (mean age: 77 years, 77% male, 93% White). Cystoscopy was not performed every 3-4 months for 40% (CIS) and 43% (PAP) of patients after diagnosis. A subsequent TURBT within 6 weeks of an initial TURBT was observed among 32% (CIS) and 33% (PAP) of patients. Following HR-NMIBC diagnosis, 29% of CIS patients and 44% of PAP patients did not initiate BCG within 90 days, while 8% of CIS patients and 11% of PAP patients did not initiate BCG within 180 days of diagnosis. Hospital readmission within 30 days of discharge was observed for 25% and 22% of CIS and PAP patients, respectively. Hospital readmission within 90 days after cystectomy was observed for 50% (CIS) and 44% (PAP) of patients, while death within 90 days of cystectomy was only observed in CIS patients (4%). Conclusions: Significant gaps in care remain for BCG-unresponsive HR-NMIBC patients with CIS as well as papillary type carcinoma, in terms of monitoring, treatment, and healthcare services received. More routine assessment of HR-NMIBC-related QoC measures may address gaps in care and improve patient outcomes.