Why is perioperative chemotherapy for bladder cancer underutilized?

Area of Science:

• Oncology
• Urology
• Health Services Research

Background:

• International guidelines recommend perioperative chemotherapy for muscle-invasive bladder cancer.
• Current clinical practice shows low utilization of this treatment modality.
• Understanding the reasons for this underuse is critical for improving patient care.

Purpose of the Study:

• To explore known factors contributing to the underutilization of perioperative chemotherapy for muscle-invasive bladder cancer.
• To propose a framework for knowledge translation to enhance treatment delivery.
• To improve care and outcomes for patients with muscle-invasive bladder cancer.

Main Methods:

• This is a commentary based on existing literature and clinical experience.
• The authors synthesize current knowledge on barriers to perioperative chemotherapy adoption.
• A framework for future interventions is proposed.

Main Results:

• Several factors contribute to the low use of perioperative chemotherapy, including issues related to patient selection, treatment delivery, and systemic barriers.
• Existing knowledge translation strategies may be insufficient to bridge the gap between guidelines and practice.
• A structured approach is needed to address the multifaceted challenges.

Conclusions:

• The underutilization of perioperative chemotherapy for muscle-invasive bladder cancer persists despite strong evidence.
• Addressing the identified barriers through targeted knowledge translation is essential.
• Implementing the proposed framework can guide efforts to improve treatment adherence and patient outcomes.