Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Scientific Session I: Oncology I 8 Determinants of Risk-aligned Bladder Cancer Surveillance - Mixed- Methods Evaluation using the Tailored Implementation for Chronic Diseases Framework Florian R. Schroeck, MD, MS 1 , A. Aziz Ould Ismail, MD, MS 2 , Grace N. Perry, BA 3 , David Haggstrom, MD, MAS 4 , Steven L. Sanchez, BS 4 , DeRon Walker, MHA 4 , Jeanette Young, MA 5 , Susan Zickmund, PhD 5 , Lisa Zubkoff, PhD 6 1 WRJ VAMC andDartmouth College, Lebanon, NH, USA; 2 WRJ VAMC, White River Junction, VT, USA; 3 University of Utah, Salt Lake City, UT, USA; 4 Roudeboush VAMedical Center, Indianapolis, IN, USA; 5 Salt Lake City VAMedical Center, Salt Lake City, UT, USA; 6 Birmingham/Atlanta VA GRECC, Birmingham, AL, USA Introduction: Guidelines for surveillance of patients with non-muscle invasive bladder cancer recommend aligning surveillance frequency with underlying cancer risk. We previously found that risk-aligned surveillance is not commonly provided. Lack of risk-aligned surveillance means too many unnecessary surveillance cystoscopy procedures for low-risk patients and not enough surveillance for high-risk patients with associated delays in detection of cancer recurrence. This mixed-methods study sought to examine whether practice determinants differ between sites where risk-aligned surveillance was more common (“risk-aligned sites”) versus those where risk-aligned surveillance was less common (“need improvement sites”). Materials & Methods: We used our prior quantitative data to identify two “risk-aligned sites” and four “need improvement sites” within the Department of Veterans Affairs (VA). Across these sites, we sampled 40 VA staff members (18 bladder cancer providers, 5 nurses, 5 schedulers, and 12 leaders). We performed semi-structured interviews guided by the Tailored Implementation for Chronic Diseases framework that were deductively coded. We integrated quantitative data (“risk-aligned site” versus “need improvement site”) and qualitative data from the interviews by cross- tabulating salient determinants by site type ( Table ). Results: There were 14 participants from the two “risk-aligned sites” and 26 participants from the four “need improvement sites.” Irrespective of site type, we found a lack of knowledge on guideline recommendations. Additional salient determinants at “need improvement sites” were a lack of resources (“The next available without overbooking is probably seven to eight weeks out”) and an absence of standard routines to incorporate risk-aligned surveillance (“I have my own guidelines that I’ve been using for 35 years”). Conclusions: Knowledge, resources, and lack of standard routines were salient barriers to risk-aligned bladder cancer surveillance. Implementation strategies addressing knowledge and resources can likely contribute to more risk-aligned surveillance. In addition, reminders for providers to incorporate risk into their surveillance plans may standardize their routines. Real-World Evidence for Pathological Downstaging of Muscle Invasive Bladder Cancer at Radical Cystectomy Sina Hassan Beygi Monfared, BA 1 , Sumedh Kaul, MS 2 , Aaron Fleishman, MS 2 , Ruslan Korets, MD 1 , Peter Chang, MD 1 , Andrew Wagner, MD 1 , Simon Kim, MD 3 , JoaquimBellmunt, MD, PhD 4 , Irving Kaplan, MD 5 , Aria F. Olumi, MD 1 , Boris Gershman, MD 1 1 Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; 3 Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA; 4 Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA; 5 Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA Introduction: Pathological downstaging of muscle invasive bladder cancer to no residual disease (pT0) at radical cystectomy (RC) is an important surrogate marker for favorable oncologic outcomes. Randomized data supports increased rates of pT0 at RC with neoadjuvant chemotherapy (NAC), but real-world evidence is lacking. We therefore examined real-world rates of pathological downstaging and evaluated patient and tumor characteristics associated with pT0 at RC using a nationwide oncology dataset. Materials & Methods: We identified adults with cT2-4 cN0 cM0 urothelial carcinoma of the bladder diagnosed between 2006-2016 in the National Cancer Database (NCDB) who underwent RC. Rates of pathological downstaging to pT0 and pT0 pN0 were evaluated according to baseline patient and tumor characteristics. The associations of baseline characteristics with pT0 at RC were evaluated using logistic regression. Results: A total of 10,483 patients were included in the cohort. Median age at diagnosis 68 (IQR 60-75) years, and 28% of patients received NAC. The overall rates of pT0 and pT0 pN0 were 8.1% and 7.3%, respectively. The pT0 rate was 18.3% among patients receiving NAC, and 4.3% among those who did not receive NAC (p<0.01). The rate of pT0 increased across study years (p<0.01; Figure 1 ). On multivariable analysis ( Table 1 ), gender (OR 0.82; 95% CI 0.69-0.98 for female vs male), later year of diagnosis (OR 3.41: 95% CI 1.91- 6.75 for 2016 vs. 2006), higher cT stage (OR 0.64; 95% CI 0.49-0.82 for cT3; OR 0.58; 95% CI 0.41-0.81 for cT4 vs. cT1), and receipt of NAC (OR 4.14; 95% CI 3.56-4.82) were independently associatedwith pT0 at RC. Interestingly, higher income level and educational status were associate with increased rates of pT0 on univariable analysis but not multivariable analysis. Conclusions: Real-world rates of pathological downstaging are lower than reported in randomized trial data. Univariable results suggest coexistent socioeconomic disparities. Of all patient and tumor characteristics examined, receipt of NAC was associated with the greatest likelihood of pT0 at RC. 7 5