Quality indicators

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This year's report (Norwegian only) for The Norwegian Bladder Cancer Registry, will describe certain quality indicators without using target figures. Target figures will be set during the first years of operation. Likewise, the list of quality indicators will be expanded when separate clinical forms and pathology forms have been completed and are in operation.

In the first annual report, data from the pathology reports, the Norwegian patient register and drug treatment from all the country's hospitals (Cytodose and CMS), apart from Helse Nord, will be used.

The following quality indicators, without target figures, are included in the first report:

• The proportion of patients who have a new TURB within 3 months after the first TURB with stage pT1
• The proportion of patients receiving neoadjuvant chemotherapy before cystectomy/cystoprostatectomy
• 5-year relative survival
• Proportion of cystectomies/cystoprostatectomies per health care facility

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Proportion of reTURB after first TURB with stage pT1 for patients diagnosed with bladder cancer in the period 2020–2023, based on admission area (place of residence). From fig. 2.5 in the annual report.

On a national basis, the level was 63.6 %. Among the regional health organizations there is some variation in the figures. The difference between the health institutions is greater, where respectively Østfold HF (79.3 %) and Nord-Trøndelag HF (42.9 %) have the highest and lowest proportion of reTURB. For the two health institutions, there is a big difference in the number of people diagnosed.

Since March 2021, Helse Midt-Norge has referred directly to cystectomy/cystoprostatectomy on the basis of thorough biopsies with TURB and MRI images if there has been obvious muscle infiltration. The practice leads to a higher proportion of TURBs with pT1 that do not undergo reTURB. ReTURB is also carried out here as standard after proven T1 high-grade malignant cancer.

ReTURB should usually be performed within four to six weeks of the initial TURB. This applies particularly where there is uncertainty as to whether the TURB was complete, missing muscle in the specimen, where a higher pT stage would result in a different treatment and all pT1 tumours. 10 % of tumors with stage pT1HG/G3 are found to be muscle infiltrating.

More about quality indicators in the annual report for The Norwegain Bladder Cancer Registry

The following quality indicators will be included in later annual reports when new clinical forms and PROMs and PREMs forms are finalized and put into use:

• Use of CT in assessment
• Quality of primary TURB (Muscle in the preparation for high-grade tumors)
• Degree and stage cannot be assessed: Heat damage in the preparation. Can degree, stage and diagnosis be assessed?
• Reproduction of radiological findings by histology
• Use of MDT (Concomitant CIS: have these been discussed in MDT?)
• Use of reTURB in cT1HG
• Correspondence between clinical and pathological T-stage
• Resection grooves after cystectomy/cystoprostatectomy
• Proportion of pT0 in TURB material
• Health-related quality of life at diagnosis
• Health-related quality of life 1 year after diagnosis
• Sufficient information about treatment options
• Adequate information on late effects

Quality improvements

This first annual report from the Nowegian Bladder Cancer Registry shows, as expected, that there are some differences in treatment between the health institutions. The advisory board does not wish to highlight areas for improvement in this first annual report, but will work with the figures and background for the results after publication.

It is not desirable to implement specific improvement measures based on this first annual report from the register. The professional council and the Cancer Register will together follow up the results and carry out follow-up analyzes to gain more knowledge about the data and findings, before publication of the annual report for 2024.