Real-world radical cystectomy use in high-risk non-muscle-invasive bladder cancer: a global survey.
TL;DR
Despite guideline recommendations, real-world RC use was low, and most patients offered RC refused it because of quality-of-life and safety concerns, highlighting an unmet need for alternative and efficacious bladder-preserving treatments for patients with BCG-unresponsive HR-NMIBC.
Abstract
Objectives
To evaluate real-world utilisation of radical cystectomy (RC), its acceptance and limitations, and physician perspectives on RC in patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC). PATIENTS/SUBJECTS AND
Methods
Data were obtained from the Adelphi Disease Specific Programme™, a multinational, cross-sectional survey of urologists and medical oncologists treating patients with HR-NMIBC in China, Japan, Canada, France, Germany, Italy, Spain, and the UK. Physicians reported patient demographics, clinical characteristics, treatment patterns, and patient preferences regarding HR-NMIBC treatment and surgery.
Results
Overall, 359 physicians provided data for 2583 patients (mean [standard deviation] patient age, 68.9 [9.8] years; 74% male; Stage-1 [T1] high-grade tumours 68%). Bacillus Calmette-Guérin (BCG) was used as first-line treatment in 58% (n = 1487) of patients. Among patients with recurrent HR-NMIBC, RC was used in 8% (62 of 802), 7% (13 of 188), and 8% (four of 52) at second line-of-treatment, third line-of-treatment, and fourth line-of-treatment, respectively. Physicians considered 24% of patients likely future RC candidates. Further data were collected on 825 patients who received BCG treatment. Among these patients, RC was offered to 169 (20%); 115 of these patients (68%) refused, most commonly because of quality-of-life concerns (87%), unwillingness to have a stoma (60%), and surgical safety concerns (37%).
Conclusion
Despite guideline recommendations, real-world RC use was low, and most patients offered RC refused it because of quality-of-life and safety concerns. These findings highlight an unmet need for alternative and efficacious bladder-preserving treatments for patients with BCG-unresponsive HR-NMIBC.