Unlocking better bladder cancer care with AMAZON: adaptive quantile monitoring under progressive censoring

176 Background: BC is the 6th leading cause of cancer in the US and it is estimated that 81,190 Americans will be diagnosed this year. Promoting patient knowledge and involvement in BC care have led to successful management strategies. We offered 1 hour of online education to patients and their caregivers to provide clinical and supportive information that lends a sense of control, supports effective self-management, and promotes patient-physician communication. Methods: PlatformQ Health Education, in partnership with the Bladder Cancer Advocacy Network, developed and executed an interactive education program for patients with BC and their caregivers, which was broadcast live online on cancercoachlive.com on September 29, 2017 and on-demand through March 29, 2018. The program was viewed on cancercoachlive.com by 587 learners and attracted 533 additional learners through social media channels (e.g. Facebook). Education focused on treatment options and the accessibility of resources and support. Self-reported surveys, distributed to patients and caregivers 8 weeks after the program, were analyzed for improvements in perceived engagement in their cancer care. Results: After participating in the education, a majority of the learners reported they felt knowledgeable on treatment options to discuss with their HCPs (92%, n = 60) and resources and information they can use for self-care strategies (88%, n = 58). Follow-up survey results (n = 60) also indicated that the education helped 50% of learners enhance their communication with their HCP. Moreover, 54% of learners (n = 48) felt more in control of health care decisions, and 36% of learners (n = 59) reported improvements in their health-related behaviors. Write-in examples focused on staying informed of treatments and side effects, seeking support, and proactively asking questions to their HCPs. Conclusions: As ASCO guidelines note, providing patients with preoperative information and encouraging them to take an active part in the decision-making process are essential elements to achieving positive outcomes in BC. Results from the patient survey indicate that participating in an interactive, online education program enhanced knowledge and promoted patient engagement in BC care.

Control charts are widely used in manufacturing and quality management to monitor process variability. Although easy to implement, the Shewhart control chart lacks sensitivity to small process shifts. The exponentially weighted moving average (EWMA) control chart is effective in detecting minor shifts, but responds slowly to sudden changes. To enhance the detection capability, this study adopts the adaptive EWMA (AEWMA) control chart, which features dynamic adjustment mechanisms to improve the monitoring performance. This is applicable for skewed process data, particularly those following a Gamma distribution such as lifetime data, waiting times, and current stability indicators in semiconductor manufacturing. The Wilson-Hilferty transformation was applied to approximate the normality before constructing the AEWMA control chart. Monte Carlo simulations were employed to design and evaluate both the fixed sampling interval (FSI) and variable sampling interval (VSI) schemes under various combinations of shapes, scale parameters, and smoothing constants. To address the limitations of the traditional average run length (ARL) in reflecting the differences in sampling schemes, this study also adopted the average time-to-signal (ATS) as a performance metric. The simulation results demonstrated that the AEWMA VSI chart outperformed both the AEWMA FSI and EWMA charts in terms of sensitivity and stability when detecting small process shifts.

ABSTRACTThe adaptive exponentially weighted moving average (AEWMA) control chart is a smooth combination of the Shewhart and exponentially weighted moving average (EWMA) control charts. This chart was proposed by Cappizzi and Masarotto (2003) to achieve a reasonable performance for both small and large shifts. Cappizzi and Masarotto (2003) used a pair of shifts in designing their control chart. In this study, however, the process mean shift is considered as a random variable with a certain probability distribution and the AEWMA control chart is optimized for a wide range of mean shifts according to that probability distribution and not just for a pair of shifts. Using the Markov chain technique, the results show that the new optimization design can improve the performance of the AEWMA control chart from an overall point of view relative to the various designs presented by Cappizzi and Masarotto (2003). Optimal design parameters that achieve the desired in-control average run length (ARL) are computed in several cases and formulas used to find approximately their values are given. Using these formulas, the practitioner can compute the optimal design parameters corresponding to any desired in-control ARL without the need to apply the optimization procedure. The results obtained by these formulas are very promising and would particularly facilitate the design of the AEWMA control chart for any in-control ARL value.

420 Background: To align BC treatment with patient goals, it is vital that healthcare providers (HCPs) engage their patients (pts) in SDM for treatment planning. We assessed alignment and discordances on aspects of SDM among BC pts and their urology and oncology teams. Methods: Between 05/2020 and 06/2020, surveys were administered to 53 pts with BC (48% female, mean age 68 years) and 23 HCPs, as part of in-clinic and virtual collaborative patient education sessions across 5 US-based practices. Surveys were designed to assess perceptions, preferences, and experiences with regard to SDM during BC care. Results: Survey findings indicated key alignments and discordances in pts’ reported experience and HCPs’ perceptions of the use of SDM in BC care. HCPs and pts identified the same top 2 patient goals for BC care: 1) preventing progression/recurrence (61% pts, 48% HCPs) and 2) maintaining quality of life (35% pts, 78% HCPs). When asked to identify patient’s top challenges for pts in BC care, both pts and HCPs indicated post-treatment aspects as the top challenge, though pts indicated managing side effects/serious worry about side effects from treatment as the top challenge (22%); whereas, HCPs were split evenly between managing side effects from treatment (26%) and managing life changes as a result of urinary diversion (26%). HCPs overestimated the effect that fatigue and worry had on pts capacity for SDM: only 9% of pts indicated worry or fatigue as a barrier to SDM, but 65% of HCPs indicated this as a likely barrier. Furthermore, the patient experience of SDM differed from HCP perception of SDM (Table); for some aspects of SDM, such as explaining different treatment options, explaining pros/cons of treatment options, and overall involvement in treatment decisions, fewer HCPs indicated that these aspects of SDM always or usually occurred as compared to pts. Conclusions: These findings reveal important alignments and discordances between pts and HCPs with regard to BC care and SDM, which may inform future bladder cancer and SDM initiatives. [Table: see text]

Bladder cancer (BC) is one of the most common malignancies in the United States, with over 80,000 new cases and 16,000 deaths each year. Urothelial carcinoma (UC) is the most common histology and accounts for 90% of cases. BC management is complicated by recurrence rates of over 50% in both muscle-invasive and non-muscle-invasive bladder cancer. As such, the American Urological Association (AUA) recommends that patients undergo close surveillance during and after treatment. This surveillance is in the form of cystoscopy or imaging tests, which can be invasive and costly tests. Considering this, there have been recent pushes to find complements to bladder cancer surveillance. Cell-free DNA (CfDNA), or DNA released from dying cells, and circulating tumor DNA (ctDNA), or mutated DNA released from tumor cells, can be analyzed to detect and characterize the molecular characteristics of tumors. Research has shown promising results for ctDNA use in the BC care realm. A PubMed literature review was performed finding studies discussing cfDNA and ctDNA in BC detection, prognostication, and monitoring for recurrence. Keywords used included bladder cancer, cell-free DNA, circulating tumor DNA, urothelial carcinoma, and liquid biopsy. Studies show that ctDNA can serve as prognostic indicators of both early- and late-stage BC, aid in risk stratification prior to major surgery, assist in detection of disease progression and metastatic relapse, and can assess patients who may respond to immunotherapy. The benefit of ctDNA is not confined to BC, as studies have also suggested its promise as a biomarker for neoadjuvant chemotherapy in upper-tract UC. However, there are some limitations to ctDNA that require improvements in ctDNA-specific detection methods and BC-specific mutations before widespread utilization can be achieved. Further prospective, randomized trials are needed to elucidate the true potential ctDNA has in advancements in BC care.

The diagnosis and treatment of bladder cancer represents a significant financial burden to the population in the United States. Therapeutic advances in bladder cancer care have come at a high cost to payers, providers, and patients. This study describes the principals of cost-effectiveness evaluation in healthcare and provides recommendations for a more economical use of resources in bladder cancer care. Although several studies have demonstrated that bladder cancer is a common disease associated with substantial economic burden for patients and society, the evidence supporting the cost-effectiveness of many interventions in bladder cancer care is limited and of insufficient quality. In addition, very little is known about quality of life, the preferred outcome measure for economic evaluations, associated with bladder cancer states and treatments. Moreover, current clinical guidelines for bladder cancer care do not incorporate economic factors when evaluating clinical pathways. Although cost-effectiveness studies in bladder cancer could allow us to know how healthcare dollars are being spent and assist in determining more effective ways to allocate resources, most of the currently used interventions have not undergone economic assessment.

BackgroundDespite the high prevalence of bladder cancer, research on optimal bladder cancer care is limited. One way to advance observational research on care is to use linked data from multiple sources. Such big data research can provide real-world details of care and outcomes across a large number of patients. We assembled and validated such data including (1) administrative data from the Department of Veterans Affairs (VA), (2) Medicare claims, (3) data abstracted by tumor registrars, (4) data abstracted via chart review from the national electronic health record, and (5) full text pathology reports.MethodsBased on these combined data, we used administrative data to identify patients with newly diagnosed bladder cancer who received care in the VA. To validate these data, we first compared the diagnosis date from the administrative data to that from the tumor registry. Second, we measured accuracy of identifying bladder cancer care in VA administrative data, using a random chart review (n = 100) as gold standard. Lastly, we compared the proportion of patients who received bladder cancer care among those who did versus did not have full text bladder pathology reports available, expecting that those with reports are significantly more likely to receive care in VA.ResultsOut of 26,675 patients, 11,323 (42%) had tumor registry data available. 90% of these patients had a difference of 90 days or less between the diagnosis dates from administrative and registry data. Among 100 patients selected for chart review, 59 received bladder cancer care in VA, 58 of which were correctly identified using administrative data (sensitivity 98%, specificity 90%). Receipt of bladder cancer care was substantially more common among those who did versus did not have bladder pathology available (96% vs. 43%, p < 0.001).ConclusionMerging administrative with electronic health record and pathology data offers new possibilities to validate the use of administrative data in bladder cancer research.

Adaptive control charts are getting remarkable place in statistical process control for monitoring production systems with efficiently simple design schemes. These tools are preferred to get rapid detection of shifts in manufacturing items. In this paper, a new exponentially weighted moving average function‐based adaptive control chart is proposed. The idea of design is to determine plotting exponentially weighted moving average (EWMA) statistic smoothing constant value as per system arising shift magnitude through a continuous function. As a result, the process mean shift of any size can be catered in a rapid manner than other counterparts. The Monte Carlo simulations are performed to determine the run‐length profiles of the proposed chart and the efficacy of the chart is assessed through average run length, standard deviation of run length, and the percentiles of run length. A comparative discussion with the existing adaptive EWMA (AEWMA) charts proved the efficacy of the concept for all types of small to moderate and large shifts in the favor of the concept. The proposed chart application is explained with the help of an illustrative example and a real‐life industrial dataset to get a deep insight into the concept.

The performance of control charts can be adversely affected when based on parameter estimates instead of known in‐control parameters. Several studies have shown that a large number of phase I observations may be needed to achieve the desired in‐control statistical performance. However, practitioners use different phase I samples and thus different parameter estimates to construct their control limits. As a consequence, there would be in‐control average run length (ARL) variation between different practitioners. This kind of variation is important to consider when studying the performance of control charts with estimated parameters. Most of the previous literature has relied primarily on the expected value of the ARL (AARL) metric in studying the performance of control charts with estimated parameters. Some recent studies, however, considered the standard deviation of the ARL metric to study the performance of control charts. In this paper, the standard deviation of the ARL metric is used to study the in‐control and out‐of‐control performance of the adaptive exponentially weighted moving average (AEWMA) control chart. The performance of the AEWMA chart is then compared with that of the Shewhart and EWMA control charts. The simulation results show that the AEWMA chart might represent a good solution for practitioners to achieve a reasonable amount of ARL variation from the desired in‐control ARL performance. In addition, we apply a bootstrap‐based design approach that provides protection against frequent false alarms without deteriorating too much the out‐of‐control performance. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Ambulatory bladder cancer care in the United States

Introduction: This study aims to elucidate variations in bladder cancer health outcomes and social determinants of health across diverse geographic regions in the US. It specifically investigates racial disparities in care delays among patients with bladder cancer, identifying critical intervention areas to enhance health equity. Methods: A retrospective database analysis was conducted utilizing Medicare fee-for-service data for patients with bladder cancer diagnosed between January 1, 2021, and December 31, 2022, to measure and compare rates of diagnosis, interventions (surgical or pharmacological), specialist visit, time-to-specialist visit, and diagnosis-to-treatment initiation across US racial and ethnic groups. The reference group for rates was White patients. For example, the diagnosis rate ratio for Black patients was the quotient of diagnosis rates among Black residents and diagnosis rates among White residents diagnosed with bladder cancer during the study period. Diagnosis claims with ICD-10 code C67 and ICD-9 code 188 were used. Medicare patients with at least one year of enrollment were included. Patients were excluded if their first bladder cancer diagnosis was outside the study period. Results: Diagnosis rate ratios were 0.5 for Black patients and 0.4 for Hispanic patients. Intervention rate ratios were 0.9 for Black patients and 0.8 for Hispanic patients. Specialist visit rate ratios were 0.9 for both Black patients and Hispanic patients. Median time-to-specialist visit was 21 days for all patients, while mean (standard deviation) times were 89 (162) days for Black patients, 77 (128) days for Hispanic patients, and 85 (148) days for White patients. Mean (standard deviation) diagnosis-to-treatment initiation were 29 (91) days for Black patients, 33 (94) days for Hispanic patients, and 27 (90) days for White patients; the corresponding 95% confidence interval was (29, 36) and (26, 28) for Hispanic and White patients, respectively. Conclusion: At the national level, diagnosis-to-treatment initiation for bladder cancer was significantly delayed for Hispanic patients and disparities in intervention were identified for Black and Hispanic patients in hotspots of economic inequity. Stakeholders, including population health decision makers, healthcare providers, payers, advocacy groups and policymakers, can use the study findings to design and implement strategies to reduce geographic and racial disparities, foster collaboration among key stakeholders, and improve overall healthcare quality. Citation Format: Atreyee Majumder, Daniel Erim, Arveen Kaur, Lisa Dwyer Orr. Geographic and racial disparities in bladder cancer care in the U.S. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3621.

The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR = 0.62, 95% CI = 0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.

PD14-04 INTERRUPTIONS IN BLADDER CANCER CARE DURING THE COVID-19 PUBLIC HEALTH EMERGENCY

Optimal design of adaptive EWMA monitoring schemes for the coefficient of variation and performance evaluation with measurement errors

Optimal design and evaluation of adaptive EWMA monitoring schemes for Inverse Maxwell distribution