Patient experience and unmet needs in high-risk nonmuscle-invasive bladder cancer: Insights from qualitative interviews and a cross-sectional survey

OBJECTIVES

To evaluate patient experience, unmet needs, and burden among patients with high-risk nonmuscle-invasive bladder cancer (HR-NMIBC) treated with Bacillus Calmette-Guérin (BCG).

METHODS

This cross-sectional study included HR-NMIBC patients who received BCG treatment in the past 3 years. The study, preceded by a focused literature review, was conducted in 2 phases: 1) qualitative interviews with 32 patients in the United States (US), France, Germany, and United Kingdom (UK) and 2) quantitative survey of 150 patients in the US. Both phases of the study assessed patient characteristics, treatment history, experience, and perceptions, as well as side effects, pain, discomfort, and time burden associated with BCG treatment. The quantitative survey included additional items related to BCG treatment satisfaction, health-related quality of life (HRQoL), productivity, and healthcare resource utilization. Descriptive statistics and bivariate subgroup comparisons were reported.

RESULTS

All patients in both study phases received transurethral resection of the bladder tumor (TURBT). Nearly all patients reported keeping their bladder/avoiding radical cystectomy (RC) was important (99%). Results from the quantitative survey reported a substantial impact to cancer-specific HRQoL of patients, with lower mean scores on physical (64.7), social (62.8), and role functioning (56.7) as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). Most patients (69%) were satisfied overall with BCG treatment, although satisfaction declined with increased number of side effects, higher numbers of BCG administrations, and greater discomfort (all P < 0.05).

CONCLUSIONS

Most HR-NMIBC patients were satisfied overall with BCG treatment. Approximately half of the patients had stopped BCG treatment, notably, most during the induction phase, suggesting nonadherence to guidelines which recommend maintenance treatment after induction. Future treatments should focus on delaying or avoiding recurrence and cystectomy while reducing patient discomfort and discontinuation prior to completing the recommended course of treatment.

Efficacy of fosfomycin in the prevention of postoperative infection following transurethral resection of bladder tumor during periods of limited cefazolin, cefotiam, and cefmetazole supply

INTRODUCTION

In March 2019, cefazolin availability was limited owing to the contamination of the drug substance. In addition, there was a difficulty in supplying drugs alternative to cefazolin, such as cefotiam and cefmetazole. In our Department of Nephro-urology, we used fosfomycin-based drugs to substitute cefazolin as perioperative preventive antibacterial drugs. In this study, we aimed to evaluate the usage status of perioperative prophylactic antibacterial drugs before and after the period of limited cefazolin supply and to investigate the efficacy and safety of fosfomycin sodium in preventing infections following transurethral resection of bladder tumor.

METHODS

We enrolled 346 patients who underwent transurethral resection of bladder tumor in our department from April 2018 to August 2020. The patients received the following perioperative antibacterial agents: cefotiam (n = 146), fosfomycin (n = 166), and other antibacterial agents (n = 34). There was no significant difference in the median age or surgery time.

RESULTS

The median length of hospital stay was 6, 5, and 5 days in the cefotiam, fosfomycin, and other antibacterial groups, respectively, with significant difference. The median maximum postoperative temperature was 37.1 °C in all groups, with no significant difference. There were no differences in C-reactive protein, aspartate aminotransferase, and alanine aminotransferase levels determined by postoperative blood tests; preoperative and postoperative urinary white blood cell counts; preoperative urine bacterial counts; and surgery-related infection requiring additional antibiotic treatments among the groups.

CONCLUSIONS

The use of fosfomycin-based agents helped overcome the limited supply of cefazolin without worsening clinical outcomes.

Does En-bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen?

Aims:

Detrusor muscle in initial transurethral resection of the bladder tumor (TURBT) may not be found in up to 50% of the cases. This study was done to assess the safety, feasibility and yield of detrusor muscle on en- bloc TURBT using a conventional electrocautery loop.

Materials and Methods:

Patients with bladder tumor of size 2-4 cm, from September 2007 to August 2010, who had en-bloc TURBT, were compared with patients who had conventional resection for the presence of detrusor muscle in the biopsy specimen on an initial resection. Tumor size was calculated on ultrasonography or contrast enhanced computerized tomography scan. Tumor with pedunculated base, more than 4 cm in size and tumor with hydroureteronephrosis were excluded. Conventional electrocautery loop was bent to 45° and periphery of the tumor was marked first and then the whole tumor was resected en bloc. The free-lying tumor was then cut into two or three pieces in the bladder for retrieval. Statistical analysis was done using SPSS software Version 13.

Statistical Analysis Used:

Statistical analysis was done using Pearson chi square test and P value of <.05 was considered significant.

Results:

A total of 25 patients in the control arm (with conventional TURBT) were compared with 21 patients who had en-bloc TURBT. En-bloc TURBT did not result in bladder perforation as vision was clear due to better hemostasis. Twenty of 21 (94.4%) patients had detrusor muscle but only 15 of 25 (60%) patients in the control arm had detrusor muscle on histopathological examination (P.001)

Conclusions:

En-bloc TURBT is safe and gives well-controlled resection of the whole tumor due to better visualization. Yield of detrusor muscle present in the specimen is significantly better with en-bloc TURBT.