Real‐world radical cystectomy use in high‐risk non‐muscle‐invasive bladder cancer: a global survey

Objectives To evaluate real‐world utilisation of radical cystectomy (RC), its acceptance and limitations, and physician perspectives on RC in patients with high‐risk non‐muscle‐invasive bladder cancer (HR‐NMIBC). Patients/Subjects and Methods Data were obtained from the Adelphi Disease Specific Programme™, a multinational, cross‐sectional survey of urologists and medical oncologists treating patients with HR‐NMIBC in China, Japan, Canada, France, Germany, Italy, Spain, and the UK. Physicians reported patient demographics, clinical characteristics, treatment patterns, and patient preferences regarding HR‐NMIBC treatment and surgery. Results Overall, 359 physicians provided data for 2583 patients (mean [standard deviation] patient age, 68.9 [9.8] years; 74% male; Stage‐1 [T1] high‐grade tumours 68%). Bacillus Calmette–Guérin (BCG) was used as first‐line treatment in 58% ( n  = 1487) of patients. Among patients with recurrent HR‐NMIBC, RC was used in 8% (62 of 802), 7% (13 of 188), and 8% (four of 52) at second line‐of‐treatment, third line‐of‐treatment, and fourth line‐of‐treatment, respectively. Physicians considered 24% of patients likely future RC candidates. Further data were collected on 825 patients who received BCG treatment. Among these patients, RC was offered to 169 (20%); 115 of these patients (68%) refused, most commonly because of quality‐of‐life concerns (87%), unwillingness to have a stoma (60%), and surgical safety concerns (37%). Conclusion Despite guideline recommendations, real‐world RC use was low, and most patients offered RC refused it because of quality‐of‐life and safety concerns. These findings highlight an unmet need for alternative and efficacious bladder‐preserving treatments for patients with BCG‐unresponsive HR‐NMIBC.