JU INSIGHT: Transurethral Resection of Bladder Tumor vs Chemoablation for Nonmuscle-invasive Bladder Cancer
By: Taylor Parisse, BA*; Katy Reines, MD*; Ramsankar Basak, PhD; Dana Mueller, MS; Randall Teal, MA; Maihan B. Vu, DrPH, MPH; Jessica Carda-Auten, MPH; Kathryn Stein; Kara Giannone, MPH; Robert Lipman; Angela B. Smith, MD, MS | Posted on: 17 Jan 2023
Parisse T, Reines K, Basak R, et al. Patient and provider perception of transurethral resection of bladder tumor vs chemoablation for nonmuscle-invasive bladder cancer treatment. J Urol. 2023;209(1):150-160.
Study Need and Importance
Given the need for ongoing surveillance with cystoscopy and the high likelihood of recurrence requiring transurethral resection of bladder tumor (TURBT), nonmuscle-invasive bladder cancer (NMIBC) can be burdensome for patients even when compared to other urological malignancies. As such, nonsurgical alternative treatments for NMIBC such as intravesical chemoablation are being explored with promising results. With the increasingly active role of patients in treatment decision making, understanding patient perception of intravesical chemoablation as it relates to TURBT is imperative to achieve value-based care.
What We Found
In this mixed methods study, we elicited both patient and provider perceptions of repeat TURBT as a treatment for NMIBC. Our study demonstrated a significant proportion of patients preferring intravesical chemoablation to conventional TURBT when provided with this alternative as a hypothetical treatment option for NMIBC. Furthermore, we identified differences between the way patients and urologists perceive repeat TURBT for bladder cancer. Specifically, patients but not urologists emphasized the emotional toll of the procedure along with the need for improved counseling regarding recurrence, terminology, and cancer-related signs and symptoms.
Identifying our patient sample through an advocacy network and recruiting providers through snowball sampling may introduce selection bias given that respondents may not represent the general population and providers within a similar social network may likewise counsel patients similarly. Furthermore, our sample was homogeneous with a majority of White and male respondents. Other limitations include recall bias inherent to self-reported pathological data, missingness in health-related quality of life data, and selective sampling, which may introduce respondent bias.
Interpretation for Patient Care
As alternative treatment options for NMIBC emerge, shared decision making becomes increasingly important. Understanding the burden of NMIBC treatment on quality of life is critical when framing these shared decision-making discussions. The discordance between patient and provider TURBT perception highlights the need to expand our understanding to better improve the patient experience through relevant and patient-centered education. Our study provides specific areas of discordance and ways in which they can be addressed through patient educational resources.