INDIANAPOLIS — Using one dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer is recommended in national and international guidelines.
A study published in the Journal of Urology pointed out that the surgery is performed infrequently and the impact of the decision to offer the therapy remains unclear.1
Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated eight distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer.
The Indiana University-led study team, which included participation from the Roudebush VAMC, used a ratings-based conjoint analysis method to evaluate the clinical vignette responses. “Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order,” according to the report.
The clinical vignettes were answered by 58 urologists, who make up more than 75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post-residency, the authors noted.
The most influential attributes for giving postoperative chemotherapy (utility=8.6) were an environmental attribute and having a recovery room protocol for instilling and disposing of the chemotherapy.
“The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in,” the researchers pointed out.
The authors concluded that the “study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision-making process, such as the structure of the recovery room.”
- Cary C, Tong Y, Linsell S, Ghani K, Miller DC, Weiner M, Koch MO, Perkins SM, Zimet G. Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC). J Urol. 2022 Feb;207(2):293-301. doi: 10.1097/JU.0000000000002233. Epub 2021 Sep 23. PMID: 34551594; PMCID: PMC8741637.
