Bladder Cancer Management in Brazil's Supplementary Health System: Real-World Practice Patterns

Area of Science:

• Urology
• Oncology

Background:

• Bladder cancer management requires adherence to established guidelines for optimal patient outcomes.
• The supplementary healthcare system in Brazil may present unique challenges to standard bladder cancer care.

Purpose of the Study:

• To evaluate current bladder cancer management practices among Brazilian urologists in the supplementary healthcare system.
• Identify variations and potential gaps in the real-world application of bladder cancer treatment protocols.

Main Methods:

• A cross-sectional survey was distributed to Brazilian urologists during the 2025 Brazilian Congress of Urology and electronically.
• The questionnaire assessed urologist demographics, practice characteristics, and management strategies for non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC).
• Descriptive statistics and exploratory comparisons were used to analyze collected data.

Main Results:

• 914 urologists participated, revealing near-universal cystoscopy use but limited access to enhanced imaging and flexible cystoscopy.
• Management of NMIBC was heterogeneous, with Bacillus Calmette-Guérin (BCG) use varying significantly and limited immediate postoperative intravesical chemotherapy.
• While BCG is a preferred first-line therapy, access and availability were inconsistent. Radical cystectomy volumes were generally low among practitioners.

Conclusions:

• Bladder cancer care in Brazil's supplementary healthcare system is characterized by heterogeneity, limited access to advanced technologies, and inconsistent adherence to best practices.
• Findings suggest a need for targeted educational initiatives and systemic improvements to enhance bladder cancer management.
• Limitations include potential selection bias and reliance on self-reported data, underscoring the need for cautious interpretation.