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  • Measure Summary
  • NQMC:011074
  • Jun 2016

Bladder cancer: proportion of patients with non muscle invasive bladder cancer (NMIBC) who undergo transurethral resection of bladder tumour (TURBT) who receive a single instillation of mitomycin C within 1 day of initial resection.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with non muscle invasive bladder cancer (NMIBC) who undergo transurethral resection of bladder tumour (TURBT) who receive a single instillation of mitomycin C within 1 day of initial resection.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

The recurrence rate in non muscle invasive bladder cancer (NMIBC) is as high as 70% (Kurth et al., 2000). Tumour features (number, size, grade and stage) and quality of transurethral resection of bladder tumour (TURBT) determine overall recurrence rates. However, TURBT causes tumour cells to be dispersed within the bladder during the procedure and these could get re-implanted in the bladder mucosa, subsequently being detected as recurrence. By destroying floating cancer cells and those that have been implanted on the resection site, a single instillation of intravesical chemotherapy confers an absolute reduction in tumour recurrence of 12% (Sylvester, Oosterlinck, & van der Meijden, 2004). While there does not appear to be any difference in efficacy between the various agents (Babjuk et al., 2011), the use of mitomycin C is ubiquitous in the United Kingdom (UK) and therefore specified in the cancer quality performance indicator (QPI). A single instillation of mitomycin C within 24 hours of TURBT for NMIBC is recommended (Bladder Cancer Clinical Guideline Update Panel, 2007; Babjuk et al., 2011; The Dutch Society for Urology, 2009). The single wash should not be given if perforation of the bladder wall has occurred during the TURBT.

A single instillation of intravesical chemotherapy should be used to reduce the risk of recurrent disease following resection (Scottish Intercollegiate Guidelines Network [SIGN], 2005).

Evidence for Rationale

Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M, European Association of Urology (EAU). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. 2011 Jun;59(6):997-1008. PubMed External Web Site Policy

Bladder Cancer Clinical Guideline Update Panel. Guideline for the management of nonmuscle invasive bladder cancer: (stages Ta, T1, and Tis): 2007 update. Linthicum (MD): American Urological Association Education and Research, Inc; 2007. 133 p. [31 references]

Kurth KH, Bouffioux C, Sylvester RJ, van der Meijden AP, Oosterlinck W, Brausi M. Treatment of superficial bladder tumours: achievement and needs. The EORTC Genitourinary Group. Eur Urol. 2000;37 Suppl 3:1-9. PubMed External Web Site Policy

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

Scottish Intercollegiate Guidelines Network (SIGN). Management of transitional cell carcinoma of the bladder. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2005 Dec. 45 p. (SIGN publication; no. 85).  [161 references]

Sylvester RJ, Oosterlinck W, van der Meijden AP. A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol. 2004 Jun;171(6 Pt 1):2186-90; quiz 2435. PubMed External Web Site Policy

The Dutch Society for Urology. Bladder carcinoma. Utrecht (The Netherlands): Comprehensive Cancer Centre the Netherlands; 2009 Feb 13. 128 p.

Primary Health Components

Non muscle invasive bladder cancer (NMIBC); transurethral resection of bladder tumour (TURBT); mitomycin C

Denominator Description

All patients with non muscle invasive bladder cancer (NMIBC) who undergo initial transurethral resection of bladder tumour (TURBT) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with non muscle invasive bladder cancer (NMIBC) who undergo transurethral resection of bladder tumour (TURBT) who receive a single instillation of mitomycin C within 1 day of initial TURBT

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with non muscle invasive bladder cancer (NMIBC)* who undergo initial transurethral resection of bladder tumour (TURBT)

*Tumour, Node and Metastasis (TNM) Stage: Ta, T1, carcinoma in situ [CIS]

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
Number of patients with non muscle invasive bladder cancer (NMIBC) who undergo transurethral resection of bladder tumour (TURBT) who receive a single instillation of mitomycin C within 1 day of initial TURBT

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 60%

The tolerance within this target is designed to account for situations where patients have severe haematuria, which requires continuous irrigation or surgical intervention. It also accounts for those patients where there has been intra or extraperitoneal perforation, and those with high risk of extravasation.

Additionally, at time of transurethral resection of bladder tumour (TURBT) it is often difficult to identify if disease is superficial or invasive; therefore, in order to minimise over-treatment some patients with suspected muscle invasive bladder cancer may not therefore receive mitomycin C.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

Original Title

QPI 3 – mitomycin C following transurethral resection of bladder tumour (TURBT).

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Bladder Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Bladder Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jun

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

2018 Feb

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 3, 2017. The information was verified by the measure developer on May 23, 2017.

Copyright Statement

No copyright restrictions apply.

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