Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk, Ulyanovsk oblast, Russia.
J Cancer Educ. 2021 Oct;36(5):1005-1013. doi: 10.1007/s13187-020-01728-y.
Trimodality bladder preservation (BP) is an accepted alternative to radical cystectomy for patients with muscle invasive bladder cancer (MIBC). The global utilization of BP is variable, and practice patterns have not been previously studied in Russia. We sought to elucidate the contemporary BP practice patterns in Russia and determine the impact of the BP workshop on attitudes of Russian radiation oncologists (ROs) towards BP. The workshop was focused on patient workup, selection for BP, chemotherapy choices, radiation therapy (RT) contouring and planning, patient counseling. A total of 77 pre- and 32 matched post-workshop IRB-approved surveys, based on the workshop content, were analyzed using descriptive statistics to determine baseline clinical experience and patterns of care. The impact was judged by changes in participants' responses. A total of 56% of respondents had experience with delivering bladder-directed RT, and 60% of those treated both operable and inoperable MIBC patients. Only 10% felt uncomfortable offering an operable patient BP modality. Prior to the workshop, almost half of respondents estimated universal poor bladder (44%) and erectile functions (47%) after BP. The workshop resulted in dramatic change in participants' attitudes towards long-term urinary (Stuart-Maxwell test, p < 0.01) and sexual (exact McNemar test, p < 0.01) side effects. Prior to the workshop, only 47% of respondents routinely discussed smoking cessation (SC) with their patients, whereas after workshop, 88% agreed that SC discussion is mandatory (exact McNemar test, p = 0.04). BP for MIBC is commonly used in Russia. Our workshop resulted in dramatically improved understanding of long-term BP toxicities and inspired Russian ROs to incorporate SC counseling into routine clinical management.
三联膀胱保留治疗（BP）是肌层浸润性膀胱癌（MIBC）患者的一种替代根治性膀胱切除术的方法。BP 的全球应用情况存在差异，之前尚未对俄罗斯的 BP 应用情况进行研究。我们旨在阐明俄罗斯当代 BP 的实践模式，并确定 BP 研讨会对俄罗斯放射肿瘤学家（RO）对 BP 的态度的影响。该研讨会的重点是患者的检查、BP 的选择、化疗选择、放射治疗（RT）的轮廓和规划、患者咨询。根据研讨会的内容，共分析了 77 份会前和 32 份匹配的会后经机构审查委员会批准的调查问卷，采用描述性统计方法来确定基线临床经验和护理模式。通过参与者的回答变化来判断影响。共有 56%的受访者有过膀胱定向 RT 的经验，其中 60%的受访者治疗过可手术和不可手术的 MIBC 患者。只有 10%的受访者对为可手术患者提供 BP 治疗模式感到不舒服。在研讨会之前，近一半的受访者估计 BP 后膀胱（44%）和性功能（47%）普遍较差。研讨会使参与者对长期尿（Stuart-Maxwell 测试，p<0.01）和性功能（确切 McNemar 测试，p<0.01）副作用的态度发生了显著变化。在研讨会之前，只有 47%的受访者通常与患者讨论戒烟（SC），而在研讨会之后，88%的受访者同意 SC 讨论是强制性的（确切 McNemar 测试，p=0.04）。BP 用于 MIBC 在俄罗斯很常见。我们的研讨会极大地提高了对长期 BP 毒性的认识，并激励俄罗斯 RO 将 SC 咨询纳入常规临床管理。
