title: General adherence to guideline recommendations on initial diagnosis of bladder cancer in the United States and influencing factors.
abstract: BACKGROUND
  Because international guidelines recommend best practices regarding staging of incident bladder cancer, we determined the adherence to such recommendations in the United States, performing a large retrospective database analysis.
  
  
  METHODS
  Patients with the diagnosis of urothelial cancer were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2007. Staging procedures were identified and analyzed. As reference for published recommendations, we used the American Urological Association (AUA), European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) guidelines. Based on these sources, recommended initial staging of bladder cancer was analyzed. Of all 56,130 patients, 6148 (10.9%) had a cytologic examination, 29,677 (52.9%) had a standard urinalysis, 2882 (5.1%) underwent intravenous pyelography (IVP), 6950 (12.4%) underwent retrograde pyelography (RPG), and 8145 (14.5%) had computed tomography/magnetic resonance imaging (CT/MRI).
  
  
  RESULTS
  There was a significant trend over the years to a higher use of cytologic analysis, standard urinalysis, and CT/MRI. We observed a significant trend toward a lower rate of IVP and a stable use of RPG. The limitation of our study is that claims data are designed for payment processing, not quality measurement.
  
  
  CONCLUSIONS
  Despite published recommendations on the initial diagnosis of bladder cancer, our data show that less than half of the included patients received all the elements thought to be required for an initial diagnosis of bladder cancer as recommended by guidelines. Greater adherence to recommendations may ensure optimal treatment strategies. Appropriate treatment is critical to patient outcomes, because evidence-based therapeutic management can be practiced only if an accurate assessment of the disease takes place at the time of initial diagnosis.
authors: Department of Urology, University of California, San Francisco, San Francisco, CA; Department of Urology, Ludwig-Maximilians-University, Munich, Germany. Electronic address: alexander.karl@med.uni-muenchen.de.
authors: Alexander
authors: A
authors: Karl
authors: Department of Urology, University of Minnesota, Minneapolis, MN.
authors: Oluwakayode
authors: O
authors: Adejoro
authors: Department of Urology, University of California, Los Angeles, Los Angeles, CA.
authors: Christopher
authors: C
authors: Saigal
authors: Department of Urology, University of Minnesota, Minneapolis, MN.
authors: Badrinath
authors: B
authors: Konety
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology
keywords: Adherence to guidelines; Bladder cancer; Initial diagnosis; USA; Urologic Diseases in America Project