SESAUA 2023: Patient-Reported Treatment Burden of Intravesical Therapy for Bladder Cancer

( The 2023 SESAUA annual meeting included a bladder cancer session, featuring a presentation by Dr. Amanda Myers discussing patient-reported treatment burden of intravesical therapy for bladder cancer. Intravesical therapy is the mainstay of treatment for non-muscle invasive bladder cancer.

However, patients with non-muscle invasive bladder cancer can face time, travel, and financial barriers to access intravesical therapy which may impact patient adherence to treatment. As such, Dr. Myers and colleagues sought to quantify patient-reported treatment burden while receiving intravesical therapy for bladder cancer.

This study was a cross-sectional survey of bladder cancer patients in the Bladder Cancer Advocacy Network (BCAN) Patient Survey Network to investigate patient-reported burden of intravesical therapy. Multiple choice survey questions were developed by investigators, then iteratively revised and improved by review from clinician and patient advocate stakeholders during the 2021 BCAN annual meeting. Eligible participants received at least one dose of intravesical therapy, including BCG and/or chemotherapy, delivered in an ambulatory setting. The survey was administered in November 2021 and was available for one month to respondents.

A total of 233 patients responded to the survey (18% response rate), with a median age of 70 years (range 33-88), 36% female, and 97% white. A travel time >30 minutes to an intravesical treatment facility was reported by 55% (126/231) of patients, and 33% (77/231) reported personal out-of-pocket costs greater than $25 associated with each trip:


Additionally, 56% (129/232) brought caregivers to their appointments. More than half of patients (56%, 129/232) reported spending more than two hours on each intravesical instillation, with 18% (42/232) spending more than four hours. Missing work for intravesical installations was reported by 36% (82/230) of patients, and of those who did, the majority (70%, 57/81) missed at least half a day of work (4 or more hours). Sixty-one respondents (26%) felt the process of receiving bladder instillations adversely affected their ability to perform regular daily activities:


Finally, BCG shortages increased travel or wait time for intravesical therapy for 9% (20/229) of respondents.

Dr. Myers concluded her presentation discussing patient-reported treatment burden of intravesical therapy for bladder cancer with the following take-home messages:

  • Bladder cancer patients reported considerable travel distances, time requirements, out-of-pocket costs, and need for caregiver support in the process of receiving intravesical therapy
  • Innovative intravesical care delivery processes are needed to reduce the burden of care for our bladder cancer patients
Presented by: Amanda A. Myers, Mayo Clinic, Jacksonville, FL

Co-Authors: Benjamin Ristau2, Matthew Mossanen3, Deborah Kaye4, Mark D. Tyson5, Stephanie Chisolm6, Frank Sloan7, Angela Smith8, Timothy D. Lyon1

Affiliations: 1Department of Urology, Mayo Clinic, Jacksonville, FL, 2Division of Urology, UConn Health, Farmington, CT, 3Division of Urologic Surgery, Brigham & Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, 4Division of Urology, Duke University Medical Center, Durham, NC, 5Department of Urology, Mayo Clinic, Scottsdale, AZ, 6Bladder Cancer Advocacy Network (BCAN), Bethesda, MD, 7Department of Economics, Duke University, Durham, NC, 8Department of Urology, University of North Carolina, Chapel Hill, NC

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Amelia Island, FL, Wed, Mar 15 – Sat, Mar 18, 2023.