Patient Compliance with Maintenance Intravesical Therapy for Non-Muscle Invasive Bladder Cancer

To assess patient adherence to intravesical instillation therapy for non-muscle invasive urothelial carcinoma outside of clinical trials.

We reviewed the records of patients from 2000-2013 who received intravesical therapy for non-muscle invasive urothelial carcinoma. Patients with evidence of tumor recurrence or progression were excluded. We performed univariable and multivariable regression analysis to predict adherence to intravesical therapy.

A total of 729 patients started 861 induction cycles, 63% with BCG and 37% with mitomycin C. The rate of completion of 6 weeks induction therapy with bacillus Calmette-Guèrin and mitomycin C was similar (86% and 87%, respectively). Within the BCG cohort, 161 (35%) patients commenced the SWOG maintenance protocol after induction and 16 (10%) completed all 21 treatments. A monthly protocol for BCG was started by 87 patients (19%) and 48 (55%) completed all 9 treatments. MMC therapy was started in 270 patients, 97 of whom (36%) commenced monthly maintenance treatment, and 46 (47%) completed treatments. Median number of instillations was 7 for patients undergoing monthly maintenance therapy (MMC or BCG) and 9 for patients allocated to 3 years BCG. On multivariable analysis, recurrence after prior treatment of urothelial carcinoma was predictive of patients' adherence to treatment.

Compliance with intravesical therapy is low in clinical practice, notably for longer treatment schedules.

Urology. 2018 May 21 [Epub ahead of print]

Shlomi Tapiero, Alexander Helfand, Daniel Kedar, Ofer Yossepowitch, Andrei Nadu, Jack Baniel, David Lifshitz, David Margel

Division of Urology, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: ., Division of Urology, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.