Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States.
BACKGROUND
Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use.


OBJECTIVE
To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice


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<50ml/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.
Medical Oncology Branch, National Cancer Institute, NIH, Bethesda, MD. Electronic address: andrea.apolo@nih.gov.
Andrea B
AB
Apolo
Department of Medicine, Yale School of Medicine, Yale Cancer Center, New Haven, CT.
Joseph W
JW
Kim
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Bernard H
BH
Bochner
Biostatistics and Data Management Section, National Cancer Institute, NIH, Bethesda, MD.
Seth M
SM
Steinberg
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
Dean F
DF
Bajorin
Department of Medical Oncology, Thomas Jefferson University, Kimmel Cancer Center, Philadelphia, PA.
Wm Kevin
WK
Kelly
Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD.
Piyush K
PK
Agarwal
Department of Urology, Oregon Health and Science University, Portland, OR.
Theresa M
TM
Koppie
Division of Urology, Penn State Hershey Medical Center, Hershey, PA.
Matthew G
MG
Kaag
Developmental Therapeutics and Genitourinary Cancer Programs, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
David I
DI
Quinn
US Oncology Research, Houston, TX; Comprehensive Cancer Centers of Nevada, Las Vegas, NV.
Nicholas J
NJ
Vogelzang
Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Canada.
Srikala S
SS
Sridhar
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D009132:Muscles / Q000473:pathology*; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data*; D009361:Neoplasm Invasiveness; D011795:Surveys and Questionnaires; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*; D014572:Urology
Adjuvant chemotherapy; Medical oncologist; Muscle-invasive bladder cancer; Neoadjuvant chemotherapy; Survey