Dr. Lyon on in-home intravesical therapy in bladder cancer

In this video, Timothy D. Lyon, MD, FACS, highlights the background and key findings from the study, “Patient reported treatment burden and attitudes towards in-home intravesical therapy among patients with bladder cancer,” for which he served as the senior author. Lyon is an associate professor of urology at Mayo Clinic in Jacksonville, Florida.

Could you describe the background for this study?

The rationale for this study is we wanted to see if we could better understand some of the treatment burden and the things we ask our patients to go through in the process of receiving intravesical therapy. As you know, non-muscle invasive bladder cancer comprises about 3/4 of patients with bladder cancer, and these are potential candidates for intravesical therapy. Despite this, much of the existing work looking at treatment burden and quality of life in bladder cancer patients has been among those with advanced disease or requiring cystectomy. So, we wanted to learn a little bit more about the hardships or troubles that patients might experience in the process of accessing intravesical therapy. In addition, we had developed a hypothesis that delivering in-home intravesical therapy is a potential solution that might help offload some of these burdens based on some anecdotal conversations with a few of our patients. But we didn't have a good understanding of what a broader sample of bladder cancer patients might think about that–whether they would be excited about it [and] whether they would feel safe doing that. We wanted to assess attitudes towards that potential solution in a broader sample of bladder cancer patients.

What were the notable findings from this study?

To do this, we developed a survey through iterative revisions with feedback from multiple stakeholders, including urologists as well as bladder cancer patients to really ask about those 2 domains. We delivered this survey through the BCAN, or Bladder Cancer Advocacy Network, patient survey network, which is an online community of bladder cancer survivors that exists to answer survey questions like this. We had 233 respondents, and a couple interesting findings.

Number 1, regarding treatment burden, we found that patients reported a considerable burden in the process of getting intravesical therapy, both in terms of time, travel, need for caregiver support, and financially. Specifically, we found that 55% of survey respondents traveled 30 or more minutes 1 way to their treatment office. So, at a minimum an hour of driving time. A little over half, 56%, came with a caregiver, meaning at least 1 other person was involved in this process. In addition, about a 1/3 of our patients had to miss work for each intravesical installation. Financially speaking, about 1/3 of patients reported spending an average of $25 out of pocket for each treatment, for things like parking, gasoline, food on the road, that sort of thing. That can really add up over the course of the 6-week treatment course, particularly among some of our older patients that may be on a fixed income. We were surprised at the amount of time and money that patients were investing into receiving their therapy.

Secondly, we looked at some of the responses to the questions about in-home intravesical therapy. We were pleased and excited to see that 72% of patients reported openness to receiving in-home intravesical therapy. A little over half, 53%, thought it would be less disruptive to their lives to avoid needing to come into the office. About a quarter said it would actually be anxiety reducing, and they would feel more comfortable receiving treatment in their homes vs in a clinical setting. That said, it was not universally lauded. About 11% of patients felt that they had safety concerns about health care professionals bringing intravesical medications into their home. About 1/3, specifically 34%, thought it would be more anxiety provoking to have treatment in their home vs in a clinical setting. So, I think this goes to show that this may not be an optimal approach for everyone, and that we'll need to carefully select our patients to consider this as well as to provide a lot of education around the safety protocols and guidelines before implementing this.

This transcription has been edited for clarity.