Treatment Selection for Non-muscle-invasive Bladder Cancer in an Emerging Treatment Era: A Patient Preference Study

To elicit preferences for bladder-sparing treatments among patients with non-muscle-invasive bladder cancer (NMIBC) in the United States.

Patients with self-reported NMIBC completed an online discrete-choice experiment survey evaluating their preferences for efficacy-, safety-, and administration-related treatment attributes. Evidence-based attributes included NMIBC recurrence, progression to MIBC, mode and frequency of administration, fatigue, urinary symptoms or infection, and chance of immune-related side effects requiring steroids. In a series of direct-elicitation questions, respondents chose between fixed profiles of bladder-sparing treatment and radical cystectomy (RC). The 9-item Shared Decision-Making Satisfaction Questionnaire (SDM-Q-9) captured respondents' experiences and perspectives regarding involvement in shared treatment decisions with providers.

A total of 206 respondents completed the survey. Reduced risks of progression to MIBC and NMIBC recurrence were the most important of the attributes evaluated, followed by, in order, chance of immune-related side effects requiring steroids, mode and frequency of administration, treatment-related fatigue, and urinary symptoms or infection. In fixed direct-elicitation questions, most patients (>70%) preferred bladder-sparing treatments over RC except when comparing repeated Bacillus Calmette-Guérin treatment to RC. Over 25% of respondents disagreed with the statement "My doctor asked me which treatment option I prefer" when reflecting on their shared decision-making experiences.

Reduced risks of progression to MIBC and NMIBC recurrence had the greatest impacts on treatment choice; treatment-related side effects and administration-related attributes were less important. Most respondents preferred nonsurgical treatment options with similar clinical benefits over RC. Continued efforts to incorporate shared decision-making into NMIBC treatment decisions are warranted.