Muscle-Invasive Bladder Cancer Treatment Selection in an Emerging Treatment Era: A Patient Preference Study

To elicit preferences for available and emerging systemic treatments among patients with muscle-invasive bladder cancer in the United States.

Patients with self-reported muscle-invasive bladder cancer participated in an online discrete-choice experiment evaluating preferences for attributes of systemic treatments that could be administered with radical cystectomy or bladder-sparing approaches. Evidence-based attributes included timing and duration of therapy, time until cancer recurrence, overall survival at 5 years, and chance of treatment-related adverse events. Direct-elicitation questions offered choices among fixed profiles of bladder-sparing treatment and radical cystectomy with adjuvant and neoadjuvant systemic treatments. The 9-item Shared Decision Making Satisfaction Questionnaire (SDM-Q-9) captured patients' levels of satisfaction with treatment.

Two hundred two respondents completed the survey. Most patients preferred to keep their bladder. Improvements in efficacy were most important (overall survival at 5 years, followed by the time until cancer recurrence). The average patient was tolerant of hypothetical adverse events and willing to accept increasing levels of risk for all overall survival improvements offered. Approximately 75% of respondents chose perioperative immunotherapy plus neoadjuvant chemotherapy with radical cystectomy over neoadjuvant chemotherapy alone with radical cystectomy in a fixed-choice question. On the SDM-Q-9, almost 20% of respondents disagreed with the statement "My doctor asked me which treatment option I prefer."

Improving overall survival and delaying recurrence were the most important attributes to respondents, and they were willing to accept clinically relevant treatment-related adverse events for improvements in efficacy. Results may inform patient education and engagement in shared treatment decisions.