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Bladder-sparing Radiotherapy for Muscle-invasive Bladder Cancer: A Qualitative Study to Identify Barriers and
M Walker1, R C Doiron2, S D French3
1Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|September 28, 2017
Summary
Bladder-sparing radiotherapy for muscle-invasive bladder cancer (MIBC) is underutilized due to physician beliefs and system issues. Addressing these barriers and promoting multidisciplinary care can improve access to this vital treatment option.
Area of Science:
- Oncology
- Radiation Oncology
- Urology
Background:
- Bladder-sparing radiotherapy is a potential treatment for muscle-invasive bladder cancer (MIBC).
- Its utilization in North America may be suboptimal.
- Understanding practice-driving factors is crucial for improving patient care.
Purpose of the Study:
- To identify barriers and enablers to bladder-sparing radiotherapy use in MIBC.
- To apply the Theoretical Domains Framework (TDF) to understand physician practice patterns.
- To inform strategies for increasing the adoption of bladder-sparing radiotherapy.
Main Methods:
- Semi-structured interviews were conducted with Canadian urologists, medical oncologists, and radiation oncologists.
- The Theoretical Domains Framework (TDF) guided the interview questions.
- Interviews were transcribed, and barriers/enablers were independently identified and themed by two investigators until data saturation.
Main Results:
- Key barriers included beliefs of inferior survival compared to cystectomy, lack of urology referrals, absence of radiotherapy 'champions,' and inadequate multidisciplinary collaboration.
- Enablers comprised the presence of 'champions,' urologist beliefs in presenting radiotherapy options, institutional policies for multidisciplinary review, system facilitators (e.g., nurse navigators), and patient-initiated consultations.
Conclusions:
- Physician beliefs regarding treatment efficacy and survival outcomes are significant barriers.
- Improved access to multidisciplinary care and supportive institutional contexts are crucial enablers.
- Targeting these factors can enhance the utilization of bladder-sparing radiotherapy for MIBC.
