# Predictors of adherence to surveillance cystoscopy for patients with non‐muscle invasive bladder cancer

## TL;DR

This study finds that travel time to clinics is a major barrier for bladder cancer patients following recommended surveillance schedules, more so than socioeconomic factors.

## Contribution

The study identifies travel time as a significant predictor of adherence to surveillance cystoscopy for non-muscle invasive bladder cancer.

## Key findings

- Patients with longer travel times were less likely to adhere to surveillance guidelines.
- Patients diagnosed before 2016 were more likely to follow the schedule.
- Smokers were more likely to adhere compared to non-smokers.

## Abstract

To identify factors associated with decreased adherence to the national risk‐stratified surveillance cystoscopy schedule for non‐muscle invasive bladder cancer (NMIBC).

A retrospective, IRB‐approved review was conducted at a single academic institution to identify patients diagnosed with NMIBC who underwent cystoscopy. Patient demographics were collected and driving distance to the urology clinic was calculated. Area Deprivation Index (ADI) and Distressed Communities Index (DCI) were used as proxies for socio‐economic status (SES). Clinical data included year of diagnosis, cancer stage, risk stratification per national guidelines, pathology results and surveillance cystoscopy dates. The primary outcome was 12‐month adherence to surveillance cystoscopy. Stepwise model selection using logistic regression identified factors associated with adherence.

Of 591 patients identified, 351 had a confirmed pathological diagnosis and complete follow‐up data. After excluding 57 patients who experienced recurrence, 112/294 (38.1%) were found to be compliant with the one‐year surveillance schedule. Adherence was inversely associated with travel time to the clinic (OR 0.99, 95% CI 0.99–1.00; p = 0.015), while ADI and DCI were not statistically significant in relation to adherence. Other significant predictors included diagnosis before the 2016 guideline update where patients diagnosed pre‐2016 were much more likely to adhere (OR 4.36, 95% CI 2.32–8.55; p < 0.001), risk stratification where patients of intermediate‐ and high‐risk were much less likely to adhere than those of low‐risk (intermediate: OR 0.48, CI 0.26–0.88; p = 0.018, high risk: OR 0.14, CI 0.04–0.40; p < 0.001), and smokers were much more likely to adhere than non‐smokers (OR 1.91, CI 1.08–3.43; p = 0.028).

Travel time emerged as a significant barrier to adherence to NMIBC surveillance guidelines, whereas patients' SES did not appear to influence compliance. These findings suggest that logistical obstacles may play a more prominent role than socio‐economic factors. Incorporating telehealth solutions and local partnerships may improve adherence and outcomes for NMIBC patients.