Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States

Andrea B. Apolo, Joseph W. Kim, Bernard H. Bochner, Seth M. Steinberg, Dean F. Bajorin, Wm Kevin Kelly, Piyush K. Agarwal, Theresa M. Koppie, Matthew G. Kaag, David I. Quinn, Nicholas J. Vogelzang, Srikala S. Sridhar

Research output: Contribution to journalArticle

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Abstract

Background: Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use. Objectives: To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice. Participants and methods: A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011. Results: A total of 83 MedOncs completed the survey: 52% were based in academic centers. Most referrals were from urologists (79%). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80% and 46% of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46% and 42% of respondents, respectively. NACT was not offered by 49%, 29%, and 35% of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50. ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90%), methotrexate/vinblastine/adriamycin/cisplatin (30%), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20%), and gemcitabine/carboplatin (37%). Conclusions: Most MedOncs (79%) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.

Original languageEnglish (US)
Pages (from-to)637-644
Number of pages8
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number5
DOIs
StatePublished - Jan 1 2014

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Urinary Bladder Neoplasms
Drug Therapy
Muscles
gemcitabine
Cisplatin
Neoadjuvant Therapy
Vinblastine
Methotrexate
Doxorubicin
Carcinoma
faropenem medoxomil
Carboplatin
Adjuvant Chemotherapy
Oncologists
Glomerular Filtration Rate
Surveys and Questionnaires
Referral and Consultation

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology

Cite this

Apolo, A. B., Kim, J. W., Bochner, B. H., Steinberg, S. M., Bajorin, D. F., Kevin Kelly, W., ... Sridhar, S. S. (2014). Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States. Urologic Oncology: Seminars and Original Investigations, 32(5), 637-644. https://doi.org/10.1016/j.urolonc.2013.12.012
Apolo, Andrea B. ; Kim, Joseph W. ; Bochner, Bernard H. ; Steinberg, Seth M. ; Bajorin, Dean F. ; Kevin Kelly, Wm ; Agarwal, Piyush K. ; Koppie, Theresa M. ; Kaag, Matthew G. ; Quinn, David I. ; Vogelzang, Nicholas J. ; Sridhar, Srikala S. / Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States. In: Urologic Oncology: Seminars and Original Investigations. 2014 ; Vol. 32, No. 5. pp. 637-644.
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abstract = "Background: Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use. Objectives: To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice. Participants and methods: A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011. Results: A total of 83 MedOncs completed the survey: 52{\%} were based in academic centers. Most referrals were from urologists (79{\%}). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80{\%} and 46{\%} of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46{\%} and 42{\%} of respondents, respectively. NACT was not offered by 49{\%}, 29{\%}, and 35{\%} of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50. ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90{\%}), methotrexate/vinblastine/adriamycin/cisplatin (30{\%}), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20{\%}), and gemcitabine/carboplatin (37{\%}). Conclusions: Most MedOncs (79{\%}) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.",
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Apolo, AB, Kim, JW, Bochner, BH, Steinberg, SM, Bajorin, DF, Kevin Kelly, W, Agarwal, PK, Koppie, TM, Kaag, MG, Quinn, DI, Vogelzang, NJ & Sridhar, SS 2014, 'Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States', Urologic Oncology: Seminars and Original Investigations, vol. 32, no. 5, pp. 637-644. https://doi.org/10.1016/j.urolonc.2013.12.012

Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States. / Apolo, Andrea B.; Kim, Joseph W.; Bochner, Bernard H.; Steinberg, Seth M.; Bajorin, Dean F.; Kevin Kelly, Wm; Agarwal, Piyush K.; Koppie, Theresa M.; Kaag, Matthew G.; Quinn, David I.; Vogelzang, Nicholas J.; Sridhar, Srikala S.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 32, No. 5, 01.01.2014, p. 637-644.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States

AU - Apolo, Andrea B.

AU - Kim, Joseph W.

AU - Bochner, Bernard H.

AU - Steinberg, Seth M.

AU - Bajorin, Dean F.

AU - Kevin Kelly, Wm

AU - Agarwal, Piyush K.

AU - Koppie, Theresa M.

AU - Kaag, Matthew G.

AU - Quinn, David I.

AU - Vogelzang, Nicholas J.

AU - Sridhar, Srikala S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use. Objectives: To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice. Participants and methods: A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011. Results: A total of 83 MedOncs completed the survey: 52% were based in academic centers. Most referrals were from urologists (79%). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80% and 46% of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46% and 42% of respondents, respectively. NACT was not offered by 49%, 29%, and 35% of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50. ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90%), methotrexate/vinblastine/adriamycin/cisplatin (30%), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20%), and gemcitabine/carboplatin (37%). Conclusions: Most MedOncs (79%) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.

AB - Background: Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use. Objectives: To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice. Participants and methods: A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011. Results: A total of 83 MedOncs completed the survey: 52% were based in academic centers. Most referrals were from urologists (79%). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80% and 46% of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46% and 42% of respondents, respectively. NACT was not offered by 49%, 29%, and 35% of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50. ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90%), methotrexate/vinblastine/adriamycin/cisplatin (30%), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20%), and gemcitabine/carboplatin (37%). Conclusions: Most MedOncs (79%) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.

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