United in Choice: The Critical Role of Shared Decision-Making for Patients with Bladder Cancer

Sponsored by Johnson & Johnson

Written by Ashish M. Kamat, MD, MBBS

It’s a scenario we encounter all too often: patients arrive, visibly anxious, with the impression that their only viable treatment for bladder cancer is a radical cystectomy. While the surgery can be lifesaving, it carries significant personal costs.

Today, however, more patients are actively engaged in their care, seeking personalized treatment plans that consider their medical needs and overall quality of life. They want options that can spare the bladder and allow them to maintain daily routines. As clinicians, it’s crucial that we stay updated on emerging therapies and guide patients through all available options.

Evolving Bladder Cancer Treatment Landscape

The standard of care in certain kinds of bladder cancer hasn’t significantly changed in 40 years.¹ This includes non-muscle invasive bladder cancer (NMIBC), which accounts for 75% of new bladder cancer cases and often behaves more like a chronic condition, requiring ongoing care and vigilance due to high recurrence rates among patients with high-risk disease.^2,3 Treatment options have traditionally consisted of radical cystectomy, chemotherapy, radiation, and immunotherapy, particularly Bacillus Calmette-Guerin (BCG) for NMIBC.^3,4

BCG has been central to treatment for decades in NMIBC,¹ but nearly 40% of patients experience recurrence after BCG,^5,6 leaving some to eventually face radical cystectomy as the best option.⁷ I’ve seen patients of all ages, including a nonagenarian who years later shared photos from a hot-air balloon adventure with family. Still, the surgery is life-changing, and there’s a real need for bladder-sparing alternatives for some patients.

While we’re making strides in deferring radical cystectomy for some, patients still worry about merely delaying the inevitable. My hope is for a future where we can replace radical cystectomy with less invasive, equally effective options.

A bladder cancer diagnosis is never easy, but today’s patients are facing it with more options than ever before. The standard treatment landscape is shifting, with new therapies after BCG, including refined chemotherapy delivery, gene therapies, enhanced immunotherapies, and renewed interest in radiation for early-stage disease.⁸

Personalized Guidance in Treatment Choices

Clinicians are not only cancer-treaters but also guides, helping patients navigate complex decisions about their care. Every patient is different; some want detailed knowledge about their diagnosis, recurrence risks and emerging therapies, while others feel overwhelmed and prefer a simpler approach. At the beginning, I make a point to ask, “What’s your most important question?” and meet each patient at their comfort level, whether they seek full transparency or need a slower, gentler approach to absorb their situation. Personalized care requires listening—truly listening—to what matters most to each patient and their families.

Having these open conversations and providing unbiased, comprehensive information enables patients to make well-informed decisions that align with their needs.

Embracing Change and Educating for Empowerment

It's our responsibility as urologists and oncologists to bring these options to our patients, fostering a collaborative, patient-centered approach to treatment. Patients are increasingly involved in their own care, whether by seeking second opinions or exploring clinical trials, and our role includes providing the knowledge and support they need to feel empowered. When patients understand their options, their outcomes—and peace of mind—improve.

In my experience, nothing is more rewarding than hearing a patient say, “We made the decision together.”

This collaborative approach not only builds trust and leads to better outcomes but also instills hope in the face of bladder cancer.

For further information on bladder cancer treatment, visit Inside Bladder Cancer.

References:

1. Jiang S, Redelman-Sidi G. BCG in bladder cancer immunotherapy. Cancers (Basel). 2022;14(13):3073. doi:10.3390/cancers14133073
2. National Cancer Institute: Surveillance, Epidemiology, and End Results Program. Cancer stat facts: bladder cancer. Accessed October 15, 2024. https://seer.cancer.gov/statfacts/html/urinb.html
3. Grabe-Heyne K, Henne C, Mariappan P, Geiges G, Pöhlmann J, Pollock RF. Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol. 2023;13:1170124. doi:10.3389/fonc.2023.1170124
4. American Cancer Society. Treating bladder cancer. Accessed October 15, 2024. https://www.cancer.org/cancer/bladder-cancer/treating.html
5. Böhle A, Jocham D, Bock PR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol. 2003;169(1):90-95. doi:10.1016/S0022-5347(05)64043-8
6. Han RF, Pan JG. Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials. Urology. 2006;67(6):1216-1223. doi:10.1016/j.urology.2005.12.014
7. Aminoltejari K, Black PC. Radical cystectomy: a review of techniques, developments and controversies. Transl Androl Urol. 2020;9(6):3073-3081. doi:10.21037/tau.2020.03.23
8. Lopez-Beltran A, Cookman MS, Guercio BJ. Advances in diagnosis and treatment of bladder cancer. BMJ. 2024;384:e076743. https://doi.org/10.1136/bmj-2023-076743