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Background <p>Bacillus Calmette-Guérin (BCG) therapy is the standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). The South West Oncology Group (SWOG) protocol recommends 27 instillations over 36&#xa0;months to optimise outcomes; however, adherence to this intensive regimen remains challenging worldwide.</p> Aim <p>To assess compliance with the SWOG BCG protocol within our institution, identify barriers to adherence, and highlight areas for quality improvement and cost efficiency.</p> Methods <p>A retrospective review was conducted of patients who commenced BCG induction between January 2021 and December 2023. Data collected included demographics, tumour grade, cystoscopy timing, and adherence to the BCG protocol. Deviations and reasons for non-compliance were extracted from clinical documentation. Cost implications of incomplete therapy were analysed.</p> Results <p>Thirty-four patients received 38 BCG induction courses. All completed induction, and 79.4% progressed to maintenance therapy. Only 5.8% completed the full SWOG protocol, while 58.8% remained on schedule. Reasons for discontinuation included comorbidities (<i>n</i> = 5), patient choice (<i>n</i> = 2), and undocumented factors (<i>n</i> = 4). Delays in maintenance initiation occurred in 23% of cases, primarily after induction. An estimated €20,650 was spent on BCG instillations without clinical benefit due to incomplete therapy. Fragmented documentation within the electronic medical record (EMR) contributed to reduced adherence.</p> Conclusion <p>Institutional BCG compliance mirrors international trends but highlights opportunities for improvement in patient selection, scheduling, and EMR use. A centralized EMR template has been implemented to streamline care, improve adherence, and enhance both clinical and cost outcomes.</p>

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Adherence to Bacille Calmette-Guerin protocol in the management of non-muscle invasive bladder cancer at St James’s Hospital

  • 期刊论文

  • 发表日期：

    2026年1月17日

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  • Jody SA Khan,
  • Peter E Lonergan,
  • Louise C McLoughlin

摘要

Background

Bacillus Calmette-Guérin (BCG) therapy is the standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). The South West Oncology Group (SWOG) protocol recommends 27 instillations over 36 months to optimise outcomes; however, adherence to this intensive regimen remains challenging worldwide.

Aim

To assess compliance with the SWOG BCG protocol within our institution, identify barriers to adherence, and highlight areas for quality improvement and cost efficiency.

Methods

A retrospective review was conducted of patients who commenced BCG induction between January 2021 and December 2023. Data collected included demographics, tumour grade, cystoscopy timing, and adherence to the BCG protocol. Deviations and reasons for non-compliance were extracted from clinical documentation. Cost implications of incomplete therapy were analysed.

Results

Thirty-four patients received 38 BCG induction courses. All completed induction, and 79.4% progressed to maintenance therapy. Only 5.8% completed the full SWOG protocol, while 58.8% remained on schedule. Reasons for discontinuation included comorbidities (n = 5), patient choice (n = 2), and undocumented factors (n = 4). Delays in maintenance initiation occurred in 23% of cases, primarily after induction. An estimated €20,650 was spent on BCG instillations without clinical benefit due to incomplete therapy. Fragmented documentation within the electronic medical record (EMR) contributed to reduced adherence.

Conclusion

Institutional BCG compliance mirrors international trends but highlights opportunities for improvement in patient selection, scheduling, and EMR use. A centralized EMR template has been implemented to streamline care, improve adherence, and enhance both clinical and cost outcomes.