Desai Avani, Bouknight Lucas, Reed Thomas, Mueller Dana, Osterman Chelsea, Repka Michael, Rose Tracy, Smith Angela B
Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
Bladder Cancer Advocacy Network, Bethesda, MD, USA.
Bladder Cancer. 2024 Jun 18;10(2):145-155. doi: 10.3233/BLC-240002. eCollection 2024.
In 2023, an estimated 82,290 individuals were diagnosed with bladder cancer in the United States. For muscle-invasive bladder cancer (MIBC), the American Urological Association recommends offering radical cystectomy with cisplatin-based neoadjuvant chemotherapy. However, patients are increasingly requesting alternative treatments.
To describe factors influencing selection of radical cystectomy with cisplatin-based neoadjuvant chemotherapy (NAC + RC), radical cystectomy monotherapy (RC), or tri-modality therapy (TMT) among patients with MIBC.
Individual, semi-structured phone interviews were conducted with 18 adults who underwent MIBC treatment at the University of North Carolina, recruiting six patients each from three treatment groups: 1) NAC + RC, 2) RC, and 3) TMT. Interview transcriptions were qualitatively analyzed using QSR NVivo, with major themes and sub-themes extracted. Patients also completed the Shared Decision-Making Questionnaire (SDM-Q-9; range 0-100).
Concern for survival and risks, quality of life, and varied patient preferences for involvement influenced the decision-making process. Concern surrounding sexual function, bladder preservation, and urostomy bags drove patients towards TMT. High levels of shared decision-making were observed overall, with a median SDM-Q-9 score of 95 (IQR 89-100). Patients undergoing TMT reported the highest median SDM-Q-9 score (97, IQR 94-100), while those receiving radical cystectomy alone had the lowest (66, IQR 37-96).
Patients with MIBC described a multifaceted treatment decision-making process, highlighting key influences, concerns, and unmet needs. Understanding this process can help address misconceptions and align treatment choices with patient goals. Physicians can use these insights to engage in shared decision-making, ultimately improving patient experiences and outcomes.
2023年，美国估计有82290人被诊断出患有膀胱癌。对于肌层浸润性膀胱癌（MIBC），美国泌尿外科学会建议采用基于顺铂的新辅助化疗进行根治性膀胱切除术。然而，患者越来越多地要求采用替代治疗方法。
描述影响MIBC患者选择基于顺铂的新辅助化疗联合根治性膀胱切除术（NAC+RC）、单纯根治性膀胱切除术（RC）或三联疗法（TMT）的因素。
对18名在北卡罗来纳大学接受MIBC治疗的成年人进行了个人半结构化电话访谈，从三个治疗组中各招募6名患者：1）NAC+RC，2）RC，3）TMT。使用QSR NVivo对访谈转录本进行定性分析，提取主要主题和子主题。患者还完成了共同决策问卷（SDM-Q-9；范围0-100）。
对生存和风险、生活质量的担忧以及患者对参与的不同偏好影响了决策过程。对性功能、膀胱保留和尿造口袋的担忧促使患者选择TMT。总体观察到高水平的共同决策，SDM-Q-9评分中位数为95（四分位间距89-100）。接受TMT的患者报告的SDM-Q-9评分中位数最高（97，四分位间距94-100），而仅接受根治性膀胱切除术的患者评分最低（66，四分位间距37-96）。
MIBC患者描述了一个多方面的治疗决策过程，突出了关键影响因素、担忧和未满足的需求。了解这一过程有助于消除误解，并使治疗选择与患者目标保持一致。医生可以利用这些见解进行共同决策，最终改善患者体验和治疗结果。
