Which factor impels offering of postoperative chemotherapy in nonmuscle invasive bladder cancer?

A recent study has shown clear preferences by urologists when providing postoperative immediate chemotherapy in nonmuscle invasive bladder cancer (NMIBC). Factors beyond clinical variables, such as the structure of the recovery room, play a role in this decision-making process.

A team of investigators sought to understand the significance of potential environmental and clinical factors involved in the decision to offer this therapy. They assessed urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC), who rated eight distinct clinical vignettes involving patients with NMIBC.

Responses were evaluated using a ratings-based conjoint analysis method. Each vignette included four clinical and two environmental dimensions, with each dimension consisting of two possible attributes. The investigators then derived the relative importance of each attribute from the regression model and ranked these in order.

Fifty-eight urologists (median age 53 years, median years in practice 20 years postresidency) completed the clinical vignettes, representing >75 percent of MUSIC sites.

The most influential attribute for giving postoperative chemotherapy among urologists was environmental in nature, namely, having a recovery room protocol for instilling and disposing of the chemotherapy (utility, 8.6). In addition, tumour grade (utility, 4.9) was the clinical attribute with the strongest preference for giving chemotherapy.

Of note, these preferences varied by different subgroups of urologists, particularly with respect to the type of practice a urologist was in.

“National and international guidelines recommend the use of one dose of intravesical chemotherapy immediately following surgery for NMIBC, which is performed infrequently on a population level,” the investigators said.