Patient-reported Outcomes of Blue Light Flexible Cystoscopy with Hexaminolevulinate (HAL) in the Surveillance of Bladder Cancer: Results from a Prospective Multi-center Study

This prospective, multi-center, phase III study evaluated blue light flexible cystoscopy (BLFC) with Hexaminolevulinate (HAL) in office surveillance of patients with non-muscle invasive bladder cancer at high risk of recurrence. We evaluated the impact on pain, anxiety, subjective value of the test, and willingness to pay.

The PROMIS Anxiety, Pain and "Was It Worthwhile" questionnaires were administered at baseline, after surveillance with BLFC, and after resection for those referred to the OR. Comparisons of scores were performed between groups.

A total of 304 patients were enrolled, of whom 103 were referred for OR examination. Sixty-three were found to have histologically confirmed malignancy. Pain levels were low throughout the study. Anxiety levels decreased after BLFC (Δ = -2.6) with greater decrease among those with negative pathology results (p=0.051). No differences in anxiety were noted based on gender, BLFC results, or test performance (true positive/false positive). Most patients found BLFC "worthwhile" (94%), would "do it again" (94%) and "would recommend it to others" (91%), with no differences based on BLFC result or test performance. Most patients undergoing BLFC (76%) were willing to pay out-of-pocket.

Anxiety decreased following BLFC in patients with negative pathology including patients with false positive results. The majority of patients undergoing BLFC were willing to pay out-of-pocket, found the procedure worthwhile and would recommend it to others, irrespective of whether they had a positive BLFC or false positive in the OR. This article is protected by copyright. All rights reserved.

BJU international. 2018 Jul 06 [Epub ahead of print]

Angela Smith, Siamak Daneshmand, Sanjay Patel, Kamal Pohar, Edouard Trabulsi, Michael Woods, Tracy Downs, Willim Huang, Jeffrey Jones, Michael O'Donnell, Trinity Bivalacqua, Joel DeCastro, Gary Steinberg, Ashish Kamat, Matthew Resnick, Badrinath Konety, Mark Schoenberg, J Stephen Jones, Yair Lotan, Flexible Blue Light Study Group Collaborators

University of North Carolina, Chapel Hill, NC., University of Southern California, Los Angeles, CA., University of Oklahoma, Oklahoma City, OK., Ohio State University, Columbus, OH., Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA., University of Wisconsin, Madison, WI., New York University School of Medicine, New York, NY., ME DeBakey VA Medical Center, Houston, TX., University of Iowa, Iowa City, IA., Johns Hopkins University, Baltimore, MD., Columbia University Medical Center, New York, NY., University of Chicago, Chicago, IL., University of Texas - MD Anderson Cancer Center, Houston, TX., Vanderbilt University, Nashville, TX., University of Minnesota, Minneapolis, MN., Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY., Cleveland Clinic, Cleveland, OH., UT Southwestern Medical Center, Dallas, TX.