title: Improving Compliance With a Single Post-Operative Dose of Intravesical Chemotherapy After Transurethral Resection of Bladder Tumour.
abstract: BACKGROUND
  Post-operative single dose intravesical chemotherapy (PSDIVC) in patients with non-muscle invasive bladder cancer has been shown to reduce recurrence rates by up to 39%. However, some studies have suggested poor compliance with PSDIVC stating logistical issues and reluctance to give chemotherapy prior to histological confirmation as some of the reasons.
  
  
  OBJECTIVE
  This study aims to analyse appropriate administration of PSDIVC practice in St. Mary's Hospital against European Association of Urology guidelines and implement an intervention bundle to improve practice.
  
  
  METHODS
  All patients that underwent transurethral resection of bladder tumour (TURBT) between March 2012 and February 2013 were analysed retrospectively to review indication for post-operative chemotherapy, instillation rates and limiting factors preventing appropriate instillation. An intervention bundle including pre-operative delivery of mitomycin C (MMC) to the theatre suite, proforma placed in the operative notes and designated roles for PSDIVC induction was introduced to improve instillation and documentation rates. Prospective re-audit data was collected over six months between July 2013 and December 2013 following intervention.
  
  
  RESULTS
  Sixty-four patients in group A underwent TURBT prior to introduction of the intervention bundle. Fifty-four patients had non-muscle invasive bladder cancer (NMIBC), which would have been eligible for PSDIVC. Fifteen (28% of NMIBC) were administered PSDIVC. Twenty-three (36% of all patients) were either given PSDIVC or had a documented contraindication. Thirty-one patients in group B underwent TURBT following induction of intervention bundle. Twelve (50% of NMIBC) patients were given PSDIVC. Twenty-eight (90% of all patients) were either given PSDIVC or had a documented contraindication.
  
  
  CONCLUSIONS
  The intervention bundle prompted increased administration of PSDIVC and documentation. Similar centres may benefit from an intervention to improve compliance.
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Luke
authors.initials: L
authors.lastname: Stroman
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Ben
authors.initials: B
authors.lastname: Tschobotko
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Hamid
authors.initials: H
authors.lastname: Abboudi
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: David
authors.initials: D
authors.lastname: Ellis
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Elsie
authors.initials: E
authors.lastname: Mensah
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Harikesh
authors.initials: H
authors.lastname: Kaneshayogan
authors.affiliation: Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, England.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Mazaris
keywords: Bladder Cancer; Bladder Neoplasms; Intravesical Instillation; Mitomycin C