# Implementing Risk-aligned Bladder Cancer Surveillance

> **NIH VA I01** · WHITE RIVER JUNCTION VA MEDICAL CENTER · 2022 · —

## Abstract

Patients with early stage bladder cancer undergo frequent surveillance cystoscopy procedures where a
camera is inserted into the bladder to detect disease recurrence. This makes cystoscopy the most common
surgical procedure in the Department of Veterans Affairs (VA) with 30,000 procedures performed annually.
There is international consensus that surveillance for early stage bladder cancer should be aligned with each
patient’s risk for recurrence and progression. Risk-aligned surveillance entails cystoscopy every year for low-
risk early stage bladder cancer and three times a year for high-risk early stage bladder cancer.
However, risk-aligned surveillance rarely occurs. In our prior work, we found that 75% of low-risk patients had
too much surveillance. Similarly, we found that 31% of high-risk patients had not enough surveillance. Overuse
among low-risk patients is undesirable, because unnecessary cystoscopy procedures lead to more discomfort,
anxiety, and costs. Underuse among high-risk patients is worrisome, because it puts them at risk for delayed
diagnosis of muscle-invasive cancer, which is associated with increased mortality. We also classified VA
facilities according to their patterns of care and found that risk-aligned surveillance was rare, with 70 of 85
facilities performing surveillance at a similar frequency for low- and high-risk patients. Little is known about the
patient, provider, and facility factors that promote risk-aligned surveillance. Thus, there is a critical need to
understand determinants of risk-aligned surveillance and to develop implementation strategies to improve risk-
aligned surveillance. Implementing risk-aligned surveillance will spare low-risk patients up to 3 unnecessary
procedures per year, while concurrently assuring appropriate surveillance among high-risk patients.
Our objective is to develop and pilot test a set of implementation strategies for risk-aligned surveillance. Our
rationale is that a set of implementation strategies including 3 to 4 targeted strategies will likely reduce both
overuse of surveillance among low-risk and underuse of surveillance among high-risk patients. Guided by the
Tailored Implementation for Chronic Diseases (TICD) framework, we will pursue the following Specific Aims: (1)
To identify provider- and facility-level barriers and facilitators for risk-aligned bladder cancer surveillance; (2) To
develop a set of implementation strategies for risk-aligned bladder cancer surveillance; (3) To pilot a set of
implementation strategies to improve risk-aligned bladder cancer surveillance.
Our study addresses the HSR&D priority area “Implementation Science”. It is the first to focus on improving
care among Veterans diagnosed with bladder cancer, the third most prevalent non-cutaneous cancer in VA, and
the first to develop a set of implementation strategies for risk-aligned cancer surveillance. We will use a mixed-
methods approach to assess provider- and facility-level barriers and facilit...

## Key facts

- **NIH application ID:** 10495367
- **Project number:** 5I01HX002780-04
- **Recipient organization:** WHITE RIVER JUNCTION VA MEDICAL CENTER
- **Principal Investigator:** Florian R Schroeck
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10495367

## Citation

> US National Institutes of Health, RePORTER application 10495367, Implementing Risk-aligned Bladder Cancer Surveillance (5I01HX002780-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10495367. Licensed CC0.

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