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Early Stage Bladder Cancer: Do Pathology Reports Tell Us What We Need to Know?

ABSTRACT: To assess a large national sample of bladder cancer pathology reports to determine if they contained the components necessary for clinical decision-making.We examined a random sample of 507 bladder cancer pathology reports from the national Department of Veterans Affairs Corporate Data Warehouse to assess whether each included information on the 4 report components explicitly recommended by the College of American Pathologists' protocol for the examination of such specimens: histology, grade, presence vs absence of muscularis propria in the specimen, and microscopic extent. We then assessed variation in the proportion of reports lacking at least 1 component across Department of Veterans Affairs facilities.One hundred eight of 507 reports (21%) lacked at least 1 of the 4 components, with microscopic extent and presence vs absence of muscularis propria in the specimen most commonly missing (each in 11% of reports). There was wide variation across facilities in the proportion of reports lacking at least 1 component, ranging from 0% to 80%.One-fifth of bladder cancer pathology reports lack information needed for clinical decision-making. The wide variation in incomplete report rates across facilities implies that some facilities already have implemented best practices assuring complete reporting whereas others have room for improvement. Future work to better understand barriers and facilitators of complete reporting may lead to interventions that improve bladder cancer care.

SUBMITTER: Schroeck FR

PROVIDER: S-EPMC5116267 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Early Stage Bladder Cancer: Do Pathology Reports Tell Us What We Need to Know?

Schroeck Florian R FR Pattison Erik A EA Denhalter Daniel W DW Patterson Olga V OV DuVall Scott L SL Seigne John D JD Robertson Douglas J DJ Sirovich Brenda B Goodney Philip P PP

Urology 20160830

<h4>Objective</h4>To assess a large national sample of bladder cancer pathology reports to determine if they contained the components necessary for clinical decision-making.<h4>Methods</h4>We examined a random sample of 507 bladder cancer pathology reports from the national Department of Veterans Affairs Corporate Data Warehouse to assess whether each included information on the 4 report components explicitly recommended by the College of American Pathologists' protocol for the examination of su ...[more]

PMID: 27590253

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Project description:ImportanceCancer care guidelines recommend aligning surveillance frequency with underlying cancer risk, ie, more frequent surveillance for patients at high vs low risk of cancer recurrence.ObjectiveTo assess the extent to which such risk-aligned surveillance is practiced within US Department of Veterans Affairs facilities by classifying surveillance patterns for low- vs high-risk patients with early-stage bladder cancer.Design setting and participantsUS national retrospective cohort study of a population-based sample of patients diagnosed with low-risk or high-risk early-stage bladder between January 1, 2005, and December 31, 2011, with follow-up through December 31, 2014. Analyses were performed March 2017 to April 2018. The study included all Veterans Affairs facilities (n = 85) where both low-and high-risk patients were treated.ExposuresLow-risk vs high-risk cancer status, based on definitions from the European Association of Urology risk stratification guidelines and on data extracted from diagnostic pathology reports via validated natural language processing algorithms.Main outcomes and measuresAdjusted cystoscopy frequency for low-risk and high-risk patients for each facility, estimated using multilevel modeling.ResultsThe study included 1278 low-risk and 2115 high-risk patients (median [interquartile range] age, 77 [71-82] years; 99% [3368 of 3393] male). Across facilities, the adjusted frequency of surveillance cystoscopy ranged from 3.7 to 6.2 (mean, 4.8) procedures over 2 years per patient for low-risk patients and from 4.6 to 6.0 (mean, 5.4) procedures over 2 years per patient for high-risk patients. In 70 of 85 facilities, surveillance was performed at a comparable frequency for low- and high-risk patients, differing by less than 1 cystoscopy over 2 years. Surveillance frequency among high-risk patients statistically significantly exceeded surveillance among low-risk patients at only 4 facilities. Across all facilities, surveillance frequencies for low- vs high-risk patients were moderately strongly correlated (r = 0.52; P < .001).Conclusions and relevancePatients with early-stage bladder cancer undergo cystoscopic surveillance at comparable frequencies regardless of risk. This finding highlights the need to understand barriers to risk-aligned surveillance with the goal of making it easier for clinicians to deliver it in routine practice.

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Early Stage Bladder Cancer: Do Pathology Reports Tell Us What We Need to Know?

Publications

Early Stage Bladder Cancer: Do Pathology Reports Tell Us What We Need to Know?

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