Hematuria and Cancer Evalution: Guidelines Mostly Not Followed By Physicians

MedicalResearch.com Interview with:
Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115Dr. Atul Shinagare MD
Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115


MedicalResearch.com: What are the main findings of the study?

Answer: We evaluated 100 randomly selected patients from a cohort of 1771 patients evaluated for asymptomatic hematuria in 2004 at our institution in order to assess physician adherence to the 2001 American Urological Association (AUA) guidelines for evaluating patients and its impact on the diagnosis of urologic cancer. We found that most (64%) patients were not evaluated according to the guidelines, that there was substantial variation in the evaluation, and that the evaluation depended largely on the type of hematuria and physician specialty. Only 5% of patients were found to have urologic cancer, and all of them were evaluated according to the guidelines. No additional urologic cancers were diagnosed in patients in whom guidelines were not followed; however, since not all patients were tested thoroughly, occult malignancies may have been present.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Other than urologists, most physicians did not follow the guidelines. We had expected a larger proportion of physicians to adhere to the guidelines. We were surprised to find that no urologic cancers were diagnosed in patients who were not evaluated according to the guidelines.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The approach to patients with asymptomatic hematuria was highly variable, and largely not guideline adherent. This could be in part due to lack of awareness or acceptance of the guidelines by clinicians. Hematuria can be the only sign of a urologic cancer, but most of the time hematuria is not due to cancer, and therefore effective guidelines are needed to maximize the chance of detecting cancer while limiting the over-utilization of diagnostic tests. Since no urologic cancers were diagnosed in patients who were not evaluated according to the 2001 guidelines (barring occult cancers) it is hoped that future guidelines could be devised such that fewer patients would need to be tested. Additional studies will be needed to evaluate the impact of the current, 2012 AUA guidelines.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: The current 2012 version of AUA guidelines have been devised to minimize the possibility of missing urologic malignancies as high quality evidence on which patients with hematuria can be safely spared an evaluation is lacking. Future research to help develop such high quality evidence will be needed before existing guidelines can be effectively improved.

Citation:

Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis
Atul B. Shinagare, Stuart G. Silverman, Esteban F. Gershanik, Steven L. Chang, Ramin Khorasani

The American Journal of Medicine – 24 February 2014 (10.1016/j.amjmed.2014.02.013)

 

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