PD32-07 BARRIERS TO SINGLE-DOSE INTRAVESICAL CHEMOTHERAPY IN NON-MUSCLE INVASIVE BLADDER CANCER: WHAT'S THE PROBLEM?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III (PD32)1 Apr 2020PD32-07 BARRIERS TO SINGLE-DOSE INTRAVESICAL CHEMOTHERAPY IN NON-MUSCLE INVASIVE BLADDER CANCER: WHAT'S THE PROBLEM? Clint Cary*, Laura Militello, Michael Weiner, Paige DeChant, Richard Frankel, and Michael Koch Clint Cary*Clint Cary* More articles by this author , Laura MilitelloLaura Militello More articles by this author , Michael WeinerMichael Weiner More articles by this author , Paige DeChantPaige DeChant More articles by this author , Richard FrankelRichard Frankel More articles by this author , and Michael KochMichael Koch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000896.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The intravesical instillation of mitomycin C immediately following surgery for non-muscle invasive bladder cancer has been shown to be efficacious in reducing cancer recurrence. This led the American Urological Association guidelines for non-muscle invasive bladder cancer care to support its use in low to intermediate risk patients. Despite this, urologists’ use of this drug following transurethral resection of a bladder tumor (TURBT) has been reported as low as 5% or less in studies and reasons for this are not well understood. METHODS: Semi-structured interviews were conducted with 13 practicing urologists at 4 geographically distinct practice locations throughout Indiana between 2017 and 2018. Cognitive task analysis was used to explore factors that influence clinician decision making about Mitomycin C use following (TURBT) in specific patient cases. Interview transcripts were coded using immersion/crystallization to identify emergent themes. RESULTS: The median age of the urologists interviewed was 44 (IQR 40-48). Eighty-five percent were male. Approximately 30% had completed urologic fellowship training; 62% were in private practice. Three major themes related to the use of mitomycin C emerged: cumbersome workflow processes, urologists’ fears of side effects, and issues with identifying patients most likely to benefit. We identified significant cumbersome workflow processes and administrative barriers of postoperative chemotherapy following a TURBT. CONCLUSIONS: Workflow, fear, and value are key factors and also represent complexities of translating efficacy into effectiveness for a drug with known benefits to patients. Moving from efficacy to effectiveness requires understanding the context and environment in which the drug is going to be used. Areas of potential intervention development to improve the use of mitomycin C to reduce recurrence of bladder cancer are suggested. Source of Funding: NIH NCI K23 Award: 1K23CA212272 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e639-e639 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clint Cary* More articles by this author Laura Militello More articles by this author Michael Weiner More articles by this author Paige DeChant More articles by this author Richard Frankel More articles by this author Michael Koch More articles by this author Expand All Advertisement PDF downloadLoading ...