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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Liu W, Tian J, Zhang S, Yang E, Shen H, Li F, Li K, Zhang T, Wang H, Svatek RS, Rodriguez R, Wang Z. The utilization status of neoadjuvant chemotherapy in muscle-invasive bladder cancer: a systematic review and meta-analysis. Minerva Urol Nephrol 2020; 73:144-153. [PMID: 31920065 DOI: 10.23736/s2724-6051.19.03648-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To give a comprehensive depiction of the utilization status of neoadjuvant chemotherapy (NAC) in muscle invasive bladder cancer (MIBC) worldwide. EVIDENCE ACQUISITION Potential relevant research papers of Pubmed, Embase, Web of Science, and the Cochrane Library were reviewed to identify eligible studies. Primary outcomes of this meta-analysis were utilization rate of NAC and its utility distribution in different genders, races, ages, countries and temporal trends. The utilization rates of NAC were calculated as 'Proportion (s)' with 95% confidence intervals (CIs) and pooled estimates were calculated by using a random-effect model. EVIDENCE SYNTHESIS A total of thirteen studies and 35,738 patients were included. The total proportion of NAC applied in MIBC populations prior to radical cystectomy (RC) was 17.2% (95% CI: 12.5-21.9%, I2=99.7%). The comparative analyses showed there were no significant differences existing in different genders or races on NAC utilization rates. In terms of age distribution, <60 age group conferred higher utilization rate of NAC than the older (OR=1.919, 95% CI: 1.671-2.202, P=0.0001). As for regional distribution, our meta-analysis showed that Japan (Proportion: 44.0%, 95% CI: 6.5-81.5%, I2=99.6%) and Sweden (37.9%, 95% CI: 34.9-40.8%) were the top two leading countries which contributed to the most frequent application of NAC. In respect of pathologic responses after NAC, complete, partial and down-staged pathologic responses were achieved in 16.6% (95% CI: 7.4-25.9%, I2=89.7%), 14.6% (95% CI: 0.8-28.5%, I2=89.7%) and 45.0% (95% CI: 17.8-72.2%, I2=98.8%) patients, respectively. CONCLUSIONS The present study shows the low utilization rate of NAC in MIBC patients. Standardization of the treatment modality of MIBC and promotion of guidelines might be necessary to expedite the adoption of NAC in near future.
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Affiliation(s)
- Wei Liu
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Jinhui Tian
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Evidence-based Medicine Center of Lanzhou University, Lanzhou, China
| | - Su Zhang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Enguang Yang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Haixiang Shen
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fudong Li
- Department of Urology, Lanzhou General Hospital of People's Liberation Army, Lanzhou, China
| | - Kailing Li
- Department of Urology, First Hospital of Lanzhou University, Lanzhou, China
| | - Tao Zhang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China
| | - Hanzhang Wang
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zhiping Wang
- Key Laboratory of Gansu Province for Urological Diseases, Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, China -
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Nguyen EK, Yu H, Pond G, Shayegan B, Pinthus JH, Kapoor A, Mukherjee SD, Neville A, Lalani AKA, Hotte SJ, Corbett TB, Dayes IS, Lukka HR. Outcomes of trimodality bladder-sparing therapy for muscle-invasive bladder cancer. Can Urol Assoc J 2019; 14:122-129. [PMID: 31702551 DOI: 10.5489/cuaj.5945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although radical cystectomy is considered the standard of care for muscle-invasive bladder cancer (MIBC), recent data has suggested comparable survival outcomes for bladder-sparing trimodality therapy (TMT). We conducted a retrospective, single-institution analysis of MIBC patients to evaluate the efficacy of TMT as an alternative, curative approach to surgical intervention. METHODS We conducted a retrospective analysis of MIBC patients assessed by a multidisciplinary team at the Juravinski Cancer Centre from 2010-2016. Patients underwent transurethral resection of bladder tumor (TURBT) followed by radiotherapy with or without concurrent chemotherapy. Patients could receive neoadjuvant treatment. Clinical data and response rates were summarized, and overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS Our analytic cohort included 115 patients, of whom 53 underwent TMT and 62 underwent radiotherapy alone following TURBT. Median age at diagnosis was 79 years and median followup was 21 months. Complete response rates in those receiving TMT and radiation without chemotherapy were 84.4% and 66.7%, respectively. For TMT patients, three-year OS and DFS were 68.5% and 49.6%, respectively. Patients who received TMT had reduction in risk of mortality (hazard ratio [HR] 0.49; p=0.026) and disease recurrence (HR 0.55; p=0.017) compared to those who had radiation without chemotherapy. Overall, four patients had grade 3 or higher late toxicity. CONCLUSIONS In this single-institution analysis, TMT appears to be a safe and effective approach in the short-term management of MIBC in appropriately selected patients. Extended followup and analysis are necessary to validate these results.
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Affiliation(s)
- Eric K Nguyen
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Hang Yu
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory Pond
- Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Som D Mukherjee
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Alan Neville
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Aly-Khan A Lalani
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Sebastien J Hotte
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Thomas B Corbett
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Ian S Dayes
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Himanshu R Lukka
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
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Harshman LC, Tripathi A, Kaag M, Efstathiou JA, Apolo AB, Hoffman-Censits JH, Stadler WM, Yu EY, Bochner BH, Skinner EC, Downs T, Kiltie AE, Bajorin DF, Guru K, Shipley WU, Steinberg GD, Hahn NM, Sridhar SS. Contemporary Patterns of Multidisciplinary Care in Patients With Muscle-invasive Bladder Cancer. Clin Genitourin Cancer 2018; 16:213-218. [PMID: 29289519 PMCID: PMC6731031 DOI: 10.1016/j.clgc.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties. MATERIALS AND METHODS In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases. RESULTS Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic. CONCLUSION Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.
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Affiliation(s)
- Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Abhishek Tripathi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew Kaag
- Penn State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Andrea B Apolo
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Evan Y Yu
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Anne E Kiltie
- Cancer Research UK/Medical Research Council, Oxford Institute for Radiation Oncology, Oxford, United Kingdom
| | | | | | | | | | - Noah M Hahn
- Johns Hopkins University School of Medicine, Baltimore, MD
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Yip SM, Kaiser J, Li H, North S, Heng DY, Alimohamed NS. Real-world Outcomes in Advanced Urothelial Cancer and the Role of Neutrophil to Lymphocyte Ratio. Clin Genitourin Cancer 2018; 16:e637-e644. [DOI: 10.1016/j.clgc.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/30/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022]
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Kassouf W, Aprikian A, Saad F, Breau RH, Kulkarni G, Guttman DM, Bagshaw K, Izawa J, Eapen L, Fairey A, So A, North S, Rendon R, Sridhar SS, Brimo F, Chung P, Drachenberg D, Fradet Y, Jacobsen N, Morash C, Shayegan B, Gotto G, Zlotta A, Fleshner N, Siemens DR, Black PC. Improving patient journey and quality of care: Summary from the second Bladder Cancer Canada-Canadian Urological Association-Canadian Urologic Oncology Group (BCC-CUA-CUOG) bladder cancer quality of care consensus meeting. Can Urol Assoc J 2018; 12:E281-E297. [PMID: 29603921 DOI: 10.5489/cuaj.5246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC
| | - Armen Aprikian
- Department of Urology, McGill University Health Centre, Montreal, QC
| | - Fred Saad
- Division of Urology, University of Montreal, Montreal, QC
| | | | - Girish Kulkarni
- Departments of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | | | - Ken Bagshaw
- Patient representatives, Bladder Cancer Canada
| | | | - Libni Eapen
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, AB
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Scott North
- Division of Medical Oncology, University of Alberta, Edmonton, AB
| | | | - Srikala S Sridhar
- Departments of Medical Oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - Peter Chung
- Departments of Radiation Oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | | | - Yves Fradet
- Division of Urology, Laval University, Quebec City, QC
| | - Niels Jacobsen
- Division of Urology, University of Alberta, Edmonton, AB
| | - Chris Morash
- Division of Urology, University of Ottawa, Ottawa, ON
| | | | | | - Alex Zlotta
- Departments of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | - Neil Fleshner
- Departments of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Booth CM, Karim S, Brennan K, Siemens DR, Peng Y, Mackillop WJ. Perioperative chemotherapy for bladder cancer in the general population: Are practice patterns finally changing? Urol Oncol 2018; 36:89.e13-89.e20. [DOI: 10.1016/j.urolonc.2017.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Nayak AL, Cagiannos I, Lavallée LT, Morash C, Hickling D, Mallick R, Breau RH. Urinary function following radical cystectomy and orthotopic neobladder urinary reconstruction. Can Urol Assoc J 2018; 12:181-186. [PMID: 29485037 DOI: 10.5489/cuaj.4877] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION An orthotopic neobladder urinary diversion aims to minimize the physical and psychological effects of radical cystectomy through avoidance of a stoma and maintenance of urethral voiding. Neobladder function reported in the literature ranges widely due to differences in patient selection and method of assessment. The objective of the study was to characterize functional outcomes of consecutive patients treated at a tertiary care hospital. METHODS A historical cohort of patients who underwent radical cystectomy with a neobladder diversion performed at The Ottawa Hospital between January 2006 and December 2014 were reviewed. Outcomes of interest were urinary continence, use of clean intermittent catheterization (CIC), post-void residual volume, and uroflowmetry at three, six, and 12 months following cystectomy. RESULTS During the study period, 158 neobladder diversions were performed. The mean age of patients was 63.1 years (standard deviation [SD] 8.1), and 81.7% were male. Significant daytime incontinence (>1 pad) three months following surgery was common (65%), but decreased to 8.6% by 12 months. Nighttime incontinence was also common at three months (54%) and improved at 12 months (20%). While no appreciable differences between men and women were observed for continence, more women performed CIC at 12 months post-surgery (59% of women; 9% of men; relative risk [RR] 0.15; 95% confidence interval [CI] 0.07-0.30). Among patients who did not catheterize, uroflowmetry and post-void residual volume parameters were stable between three and 12 months postoperative. CONCLUSIONS Daytime and nighttime incontinence is common in neobladder patients following surgery, but improves considerably with time. Correspondingly, many female neobladder patients at our institution use CIC.
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Affiliation(s)
- Ameeta L Nayak
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
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Walker M, Doiron RC, French SD, Brennan K, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. Peri-Operative Chemotherapy for Bladder Cancer: A Survey of Providers to Determine Barriers and Enablers. Bladder Cancer 2018; 4:49-65. [PMID: 29430507 PMCID: PMC5798532 DOI: 10.3233/blc-170148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Utilization of chemotherapy for patients with muscle-invasive bladder cancer (MIBC) is low. In earlier qualitative work we used the Theoretical Domains Framework (TDF) to determine barriers and enablers of chemotherapy use. In this project we aimed to determine the prevalence of these barriers and enablers in Canadian physicians. Methods: Practicing Canadian urologists, medical oncologists (MOs) and radiation oncologists (ROs) participated in a specialty-specific web-based quantitative survey to assess potential barriers and enablers to chemotherapy use. Survey questions were developed that were thematically mapped to TDF domains. Logistic regression was used to identify TDF domains associated with high referral/use of chemotherapy. Results: 110 urologists, 47 MOs and 43 ROs completed the survey; response rates were 20%, 35% and 31% respectively. The mean reported survival gain associated with neoadjuvant chemotherapy (NACT) was 9%, 8%, and 7% for urologists, MOs, and ROs respectively. Among participating urologists, the TDF domains ‘social and professional role’ (OR = 16.5, 95% CI 4.6–59.2), ‘social influences’ (OR = 5.7, 95% CI 2.4–13.4) ‘beliefs about consequences’ (OR = 4.9, 95% CI 1.8–13.3) and ‘memory, attention and decision-making’ (OR = 0.50, 95% CI 0.27–0.91) were associated with MO referral rates. Among MOs, the TDF domains ‘behavioural regulation’, ‘social influences’, and ‘social and professional role’ were associated with greater use of chemotherapy (p < 0.05). No TDF domains were associated with RO referral to MO. Conclusions: We have identified several factors associated with referral/use of chemotherapy for MIBC. Optimization of multidisciplinary patient care needs to be considered when designing future interventions to close the gap between evidence and practice.
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Affiliation(s)
- Melanie Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
| | | | - Simon D French
- Department of Public Health Sciences, Queen's University, ON, Canada.,School of Rehabilitation Therapy, Queen's University, ON, Canada
| | - Kelly Brennan
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada
| | - Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada
| | - D Robert Siemens
- Department of Oncology, Queen's University, ON, Canada.,Department of Urology, Queen's University, ON, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, ON, Canada.,Department of Oncology, Queen's University, ON, Canada.,Department of Public Health Sciences, Queen's University, ON, Canada
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10
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Walker M, Doiron RC, French SD, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. Perioperative chemotherapy for bladder cancer: A qualitative study of physician knowledge, attitudes, and behaviour. Can Urol Assoc J 2017; 12:E182-E190. [PMID: 29319482 DOI: 10.5489/cuaj.4791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Use of chemotherapy for muscle-invasive bladder cancer (MIBC) is known to be low. To understand factors driving practice we use the Theoretical Domains Framework (TDF) to identify barriers and enablers of chemotherapy use. METHODS A convenience sample of Canadian urologists, medical oncologists (MOs), and radiation oncologists (ROs) participated in individual, semi-structured, one-hour telephone interviews. An interview guide was developed using the TDF to assess potential barriers and enablers of chemotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation. RESULTS A total of 71 physicians were invited to participate and 34 (48%) agreed to be interviewed: 13 urologists, 10 MOs, and 11 ROs. We identified the following barriers to the use of chemotherapy (relevant TDF domains in parentheses): 1) belief that the benefits of chemotherapy are not clinically important (beliefs about consequences); 2) inadequate multidisciplinary collaboration (environmental context and resources); 3) absence of "champions" advocating the use of chemotherapy (social and professional role); and 4) a lack of organizational clarity/policy regarding the referral process (environmental context and resources). The predominant enablers identified included: 1) "champions" who believe in the value of chemotherapy (social and professional role); 2) urologists who refer all patients to MO (behavioural regulation; memory, attention, and decision-making); and 3) system-level factors, including automatic multidisciplinary referral (environmental context and resources). CONCLUSIONS We have identified several system-level factors associated with delivery of chemotherapy. Behaviour change interventions should optimize multidisciplinary care of patients with MIBC. PATIENT SUMMARY Despite the fact that chemotherapy before or after surgery improves survival of patients with bladder cancer, several studies have shown that many patients in routine practice are not treated. In this study, we identify important system-level and physician-level factors that must be considered in efforts to improve patient care.
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Affiliation(s)
- Melanie Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada
| | | | - Simon D French
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Walker M, Doiron RC, French SD, Feldman-Stewart D, Siemens DR, Mackillop WJ, Booth CM. Bladder-sparing Radiotherapy for Muscle-invasive Bladder Cancer: A Qualitative Study to Identify Barriers and Enablers. Clin Oncol (R Coll Radiol) 2017; 29:818-826. [PMID: 28951003 DOI: 10.1016/j.clon.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
AIMS Bladder-sparing radiotherapy for muscle-invasive bladder cancer (MIBC) may be underutilised in North America. To understand factors driving practice we used the Theoretical Domains Framework (TDF) to identify barriers and enablers of bladder-sparing radiotherapy utilisation. MATERIALS AND METHODS A convenience sample of Canadian urologists, medical oncologists and radiation oncologists participated in individual semi-structured 1 h interviews. An interview guide was developed using the TDF to assess barriers and enablers of bladder-sparing radiotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation. RESULTS In total, 71 physicians were invited to participate and 34 (48%) agreed to be interviewed; 13 urologists, 11 radiation oncologists and 10 medical oncologists. We identified the following barriers to the use of bladder-sparing radiotherapy (relevant TDF domains in parentheses): (1) beliefs that radiotherapy has inferior survival compared with cystectomy (beliefs about consequences); (2) lack of referral from urology to radiation oncology (behavioural regulation; memory, attention and decision-making); (3) lack of 'champions' who advocate for radiotherapy (social and professional role); and (4) inadequate multidisciplinary collaboration (environmental context and resources). Predominant enablers to the use of bladder-sparing radiotherapy included: (1) 'champions' who believe in the value of radiotherapy (social and professional role); (2) beliefs by urologists that radiation oncologists should present radiotherapy options to all patients (social and professional role); (3) institutional policy that all MIBC patients should be seen by multiple specialists (environmental context and resources); (4) system facilitators of radiation oncology referral (i.e. nurse navigator) (environmental context and resources); and (5) patient-driven consultations seeking alternatives to cystectomy (social influences). CONCLUSIONS These findings identify important barriers and enablers to the use of bladder-sparing radiotherapy in MIBC. Physician beliefs, access to multidisciplinary care and institutional context should be considered in efforts to increase the use of bladder-sparing radiotherapy.
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Affiliation(s)
- M Walker
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - R C Doiron
- Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - S D French
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - D Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - D R Siemens
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - W J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
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Rudzinski JK, Basappa NS, North S. Perioperative chemotherapy for muscle invasive bladder cancer. Curr Opin Support Palliat Care 2015; 9:249-54. [PMID: 26125306 DOI: 10.1097/spc.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy with or without systemic chemotherapy is considered a standard of care for patients with muscle invasive bladder cancer (MIBC). The purpose of this review is to provide an update on current and recent literature published within the last 12 months reviewing the evidence for use of perioperative chemotherapy for patients with MIBC. RECENT FINDINGS In the neoadjuvant chemotherapy (NAC) setting, the evidence demonstrates clinical efficacy and lower rate of toxicity with the use of high-dose methotrexate, vinblastine, doxorubicin, and cyclophosphamide (MVAC) compared with standard MVAC. Higher quality evidence for the use of gemcitabine with cisplatin is not yet available. Meta-analysis of cisplatin-based regimens in the adjuvant setting demonstrates significant benefit in overall survival and disease-free survival specifically in patients with lymph-node-positive disease. SUMMARY The available evidence suggests that along with radical cystectomy, cisplatin-based perioperative chemotherapy should be the standard of care in patients with MIBC with a higher quality and quantity of literature in support of the NAC approach. Adoption of perioperative chemotherapy for MIBC is on the rise in North America, which is reassuring. Novel therapeutic approaches for cisplatin-ineligible patients are currently being investigated.
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Affiliation(s)
- Jan K Rudzinski
- aDivision of Urology, Department of Surgery bDivision of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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