Background:
For well over a decade, the results of several, prospective randomized placebo controlled clinical trials performed outside North America have shown that intravesical instillation of chemotherapeutic agents immediately after transurethral bladder tumor resection (TURB) has decreased the likelihood of tumor recurrence, particularly for patients with newly diagnosed bladder cancers. In view of these data, we set out to determine whether American urologists have adopted this practice into standard care by using a large commercial insurance claims and Medicare database.
Methods:
Medstat is part of The Thomson Corporation, a healthcare information company that provides market intelligence and benchmark databases, decision support solutions, and research services for managing the cost and quality of healthcare in the US. The commercial claims and encounters database from Medstat has continuous enrollment of patients from large employers and health plans nationwide and currently follows over 6 million covered lives. The database has been previously validated as being representative for research involving oncological and non-oncological care nationwide. Using the MEDSTAT health-care consortium claims data, we identified patients with bladder cancer based on the International Classification of Disease Version 9(ICD-9) code 188.9, between the years 1997 and 2004. We then subcategorized the patients to all those who did not have any preceding bladder cancer diagnosis and underwent cystoscopy with bladder biopsy or TURB with CPT codes 52204, 52224,52234,52235,52240. We then filtered all the patients for whom any bill was submitted for intravesical instillation of any chemotherapeutic agent, including mitomycin C or interferon alpha performed on the same or the following day of their TURB by CPT and National Drug Codes.
Results:
From 1997 through 2004, 16,748 patients with newly diagnosed bladder cancer were recorded in this database; with 14,677 undergoing cystoscopy and biopsy or TURB. Of these patients, only 49 (0.33%) received same or following day intravesical instillation of a chemotherapeutic agent - mitomycin C (48) and Interferon alpha (1). When analyzed over the years 1997-2004, there have been no significant fluctuations in the rate of yearly same day intravesical administrations.
Conclusions:
Despite the wide acceptance of same day intravesical instillation of chemotherapeutic agents after TURB in Europe and Asia, this policy has not been embraced by American urologists. Reasons for this approach not being incorporated into standard practice, including barriers to its acceptance and performance, are unclear. It’s possible that an American study showing its efficacy will popularize this approach and increase acceptance.

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