title: Adherence to surveillance among patients with superficial bladder cancer.
abstract: BACKGROUND
  Patients diagnosed with superficial bladder cancer who have not undergone total cystectomy are at high risk for recurrence, and bladder surveillance with cystoscopy is recommended for such patients every 3-6 months. We examined the degree to which bladder cancer patients undergo the recommended surveillance procedures and identified patient and primary care provider characteristics associated with nonadherence to these recommendations.
  
  
  METHODS
  We used information obtained from the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare-linked database to identify 6717 patients aged 65 years or older who were diagnosed with superficial bladder cancer from 1992 through 1996 and who survived for at least 3 years after diagnosis but did not have a total cystectomy. We used information obtained from Medicare claims forms to examine the frequency with which these patients had a surveillance examination of the bladder during each of five contiguous 6-month intervals from month 7 to month 36 following diagnosis. We examined characteristics of patients and their physicians that were associated with low-intensity surveillance (defined as having an examination during fewer than two of the five possible follow-up intervals). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two-sided.
  
  
  RESULTS
  Only 40% of the entire cohort had an examination during all five intervals; 1216 patients (18.1%) had low-intensity surveillance. Patient characteristics that were independently associated with low-intensity surveillance were being age 75 years or older (adjusted OR = 1.54, 95% CI = 1.35 to 1.74), nonwhite (adjusted OR = 1.94, 95% CI = 1.57 to 2.40), and having favorable tumor histology (adjusted OR = 0.59, 95% CI = 0.48 to 0.72 for poorly differentiated versus referent well-differentiated tumor grade) and high comorbidity (adjusted OR = 1.72, 95% CI = 1.30 to 2.27). Residence in an urban area or in a census tract with low median income was also associated with low-intensity surveillance.
  
  
  CONCLUSIONS
  The actual practice of surveillance for patients with superficial bladder cancer differs substantially from the standards recommended in clinical guidelines.
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. schragd@mskcc.org
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Lillian J
authors.initials: LJ
authors.lastname: Hsieh
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
authors.forename: Peter B
authors.initials: PB
authors.lastname: Bach
authors.forename: Harry
authors.initials: H
authors.lastname: Herr
authors.forename: Colin B
authors.initials: CB
authors.lastname: Begg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015653:Cystectomy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012306:Risk; D018426:SEER Program; D055502:Secondary Prevention; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery