Neoadjuvant Chemotherapy Use in Bladder Cancer: A Survey of Current Practice and Opinions

Cowan, Nick G.; Chen, Yiyi; Downs, Tracy M.; Bochner, Bernard H.; Apolo, Andrea B.; Porter, Michael P.; Rochelle, Jeffrey C. La; Amling, Christopher L.; Koppie, Theresa M.

doi:10.1155/2014/746298

Cited by 47 publications

(31 citation statements)

References 19 publications

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“…It is in fact difficult to determine the true number of appropriate patients who should receive NAC. In a survey conducted of all active members of the Society for Urologic Oncology regarding their practice patterns and opinions regarding NAC, Cowan and colleagues [29] noted that urologic oncologists cite age, comorbidity, delay in surgery, and modest marginal benefit as the principle determinants to eschew NAC. Intriguingly, only 65% of responding urologic oncologists discussed NAC with 90% of their patients for whom RC was an option.…”

Section: Discussionmentioning

confidence: 99%

Increasing Utilization of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer in the United States

et al. 2014

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The treatment and management of advanced urothelial carcinoma of the bladder is a considerable therapeutic challenge. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients that receive neoadjuvant chemotherapy prior to radical cystectomy. Despite the overall survival benefits, results from both institutional and administrative datasets suggest that historical use of a neoadjuvant chemotherapy paradigm is remarkably low. This review will evaluate the recent trends in pre-operative chemotherapy utilization that suggest small, but progressively increased use–currently on the order of 20% of radical cystectomy patients. Additionally, this analysis will explore the various processes and structural barriers that preclude its receipt such as patient age and comorbidity, as well as physician preference, delay to potentially curable surgery, geographic region, distance to treatment facility, and socioeconomic status.

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Section: Discussionmentioning

confidence: 99%

Increasing Utilization of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer in the United States

et al. 2014

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“…When asked which factors influence nonadherence in the use of NAC in their practice (33.8% of responders), we found that the major concerns about the NAC recommendation is the delay in surgery and patient's comorbidity. Two other national surveys among US urologists reported similar worries in the utilization of NAC for MIBC [21,23]. The side effects of NAC are well known but do not seem to cause a delay in the subsequent RC.…”

Section: Mibc Gls Adherence (Q4)mentioning

confidence: 77%

Adherence to the European Association of Urology Guidelines: A National Survey among Italian Urologists

et al. 2018

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Objective: The study aimed to explore adherence to the European Urological Association (EAU) Guidelines (GLs) grade A recommendation among Italian urologists. Materials and Methods: A 13-item multiple-choice questionnaire covering oncological and non-oncological urological diseases was e-mailed to all Italian Urologist Society (Società Italiana di Urologia or SIU) members. We asked members to provide an explanation for their answer choice where needed. The quantitative data were tested using the Pearson’s chi-square test. For all statistical comparisons, significance was considered as p < 0.05. Results: Of the 2011 invited SIU members, 210 (10.4%) completed the survey. The sample was composed of 22 (10.5%) Academic Urologists (AcUs), 110 (52.4%) Attending Urologists (AtUs), 32 (15.2%) Private Practice Urologists (PPUs), and 41 (19.5%) Residents in Urology (RUs). The mean adherence to the EAU Oncologic GLs ranged from 54.5 to 97.1%, while the adherence to the non-oncologic GLs ranged from 45 to 87.6%. We found that adherence differed across the working categories assessed. Conclusion: Our survey showed that professional role, updates, and local facilities seem to be the drivers that influence the non-adherence to the GLs. Urologists who work in university hospital would be more inclined to adopt the GLs compared to those who practice in non-academic centers.

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“…Feifer et al [14] found a similar discrepancy with usage rates of 12 and 22% for NAC and AC respectively. More recent studies suggest an increase in NAC usage in the United States, while AC usage remains stable [15, 16]. Reasons commonly cited for the higher utilization for AC include concerns about the delay in surgery and delay in histopathological staging, patient preferences, perceived marginal benefit, and concerns about morbidity due to NAC [17, 18].…”

Section: Discussionmentioning

confidence: 99%

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

et al. 2018

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Background: Guidelines support the use of neoadjuvant (NAC) and adjuvant (AC) chemotherapy in muscle-invasive bladder cancer. However, data from North America reported the underutilization of NAC in favor of AC despite the lower level of scientific evidence supporting AC. We aimed to assess current practice patterns of NAC and AC in Germany. Methods: A 15-question online survey was developed and sent via email newsletters to members of the German Association of Urology and of the German Society of Residents in Urology in October 2016 to analyze current practice patterns. Results: The survey yielded 141 individual responses from 61 different German urology departments. Eighty-nine (69.0%) and 119 (93.0%) participants were stated to regularly use NAC and AC respectively. The number of participants who were stated to use NAC and AC regularly was not associated with the type of institution (academic vs. nonacademic), number of hospital beds, and number of cystectomies performed annually. Gemcitabine/cisplatin combination chemotherapy was named as the primarily used NAC regimen by 80 (95%) respondents. The median number of administered cycles was 3 for NAC and 4 for AC. In the case of cisplatin ineligibility, combination chemotherapy with gemcitabine/carboplatin was the most common regimen. Respondents stated that chemotherapy was generally administered by urologists (81% for NAC and 85% for AC). Conclusions: Our survey of current practice shows a high acceptance rate of NAC in Germany, which was independent of the type of institution. Although the scientific level of evidence for AC is lower, it still seems to be more widely accepted than NAC. NAC and AC were generally administered by urologists.

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Neoadjuvant Chemotherapy Use in Bladder Cancer: A Survey of Current Practice and Opinions

Cited by 47 publications

References 19 publications

Increasing Utilization of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer in the United States

Increasing Utilization of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer in the United States

Adherence to the European Association of Urology Guidelines: A National Survey among Italian Urologists

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

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