Ashish Kamat: Yeah. When we take care of patients with bladder cancer, sometimes we forget the human behind the patient.
Zachary Klaassen: Yeah.
Ashish Kamat: I mean, you're a busy clinician. I'm a busy clinician. I think we do a good job, but sometimes across the globe, we don't know what's happening.
Zachary Klaassen: Sure.
Ashish Kamat: We don't know patient's perceptions. We don't know physician's perceptions. So back in 2021, we published the World Bladder Cancer Patient Coalition Survey, which was a global survey across 45 countries. That had a lot of interesting data. Then of course, BCAN has a survey, The New Faces of Bladder, which they published that is US-based. And then the International Bladder Cancer Group, which I have the pleasure of leading, BCAN, World Bladder Cancer Patient Coalition came together with the support from our colleagues at J&J, who I have to give them kudos because companies don't usually do this, right?
Zachary Klaassen: Sure.
Ashish Kamat: But they funded and helped run this survey of 800 patients in six different countries and urologists.
Zachary Klaassen: Wow.
Ashish Kamat: So not just the patients and their caregivers, but also the actual physician caregivers caring for the patient and asking them, "Hey." It was a detailed questionnaire. I mean, we spent six days talking about it.
Zachary Klaassen: Sure.
Ashish Kamat: But what we presented was the high-level data that suggests that we are doing a good job figuring out from the patient how to get them cured. But sometimes we, as practitioners, you and I, might be forgetting to ask them the questions about how does it affect their daily life.
Zachary Klaassen: Sure.
Ashish Kamat: How can we help them with treatments that are more personalized to them and their family and their situation?
Zachary Klaassen: Right.
Ashish Kamat: So that's the survey, the bladder burden survey that was released in the pre-AUA event here in Washington, DC at the National Press Club.
Zachary Klaassen: Excellent. Great background. I have a personal interest in mental health research system in prostate cancer and we know in muscle-invasive bladder cancer cystectomy patients, huge risk for depression, anxiety, et cetera. Let's focus on the non-muscle-invasive bladder cancer patients. And I know you guys had some data from that. What was sort of the findings from the survey from a non-muscle-invasive bladder cancer standpoint?
Ashish Kamat: Some of the things were not surprising.
Zachary Klaassen: Sure.
Ashish Kamat: And some of the things were surprising. So I think one of the things that was not surprising at all is when patients said that they trust their physician. But then what was surprising is that some of the patients said that they trust their physician, but they maybe felt scared to ask the physician certain specific questions.
Zachary Klaassen: Right.
Ashish Kamat: Because on the side, we had the urologist also saying that they thought patients were asking them any question they wanted to.
Zachary Klaassen: Sure.
Ashish Kamat: So that was one aspect of mental health in general. There is trust in the physician, but I think the physician needs to look at that trust more as a responsibility to have the patient open up for more questions.
Zachary Klaassen: Sure.
Ashish Kamat: The other thing was patients were not sharing with the physician the impact that the treatment was having on their day-to-day living. And again, we tried to dig deep into this. This was not captured in the survey, but some of the discussion points we had is I think you recognize patients want to be good patients.
Zachary Klaassen: Yes.
Ashish Kamat: They don't want to come and they feel like they're burdening you or I if they complain about the treatment. So we're giving them, say, a drug X for their bladder cancer. They're like, "Okay, I got to stick with this. If I tell Dr. Kamat or Dr. Klaassen that it's bothering me, I couldn't go to a school function, they're going to be like, 'Why are you bothering me with this?'" But we want to hear that because if you don't-
Zachary Klaassen: And it matters to them.
Ashish Kamat: It matters to them, but it also honestly allows us to get better results from the treatment. If I know what's bothering my patient, they can't go for a graduation and that's why they skip the dose, I can tailor around that event. I don't need to skip the dose. I can say, "Hey, come two weeks later." So that openness, the ability of patients to talk to us, tell us what's depressing them about the treatment, if anything at all, what's affecting their day-to-day living, a full 30% of patients reported missing important life events because they were too scared to tell their physician.
Zachary Klaassen: Wow. That's amazing and kind of sobering, isn't it? Aside from the survey, I think we see a lot of non-muscle-invasive bladder cancer patients. We start to see that fatigue and probably some depression as they get into the really back nine of the maintenance therapy. Is there ways that we can sort of recognize that? I know we're not clinical psychologists, we're not psycho-oncologists, but just talk about the importance of being a cheerleader and helping them get through those last few doses.
Ashish Kamat: I think cheerleader is the key word, right? And there, again, it's a team effort. So I do this and I think we have to do a little bit more of this, is get the family involved. It's not just the patient. It's the spouse. And oftentimes it's the spouse that's driving the patient to come to the clinic. They chat about it. So the spouse, whether it's husband, wife, or if it's the son, daughter, whoever it is, I think getting the patient's caregivers involved early on is really important and then letting them know that... They respect our time.
Zachary Klaassen: Sure.
Ashish Kamat: So I certainly understand that, but they can reach out to our team members, our APPs, our nurses, our MAs even.
Zachary Klaassen: Sure.
Ashish Kamat: And they can chat with them. And the number of times my MA has come and said, "Hey, Dr. Kamat. This patient really is having trouble with the Gem/Doce treatment, didn't want to tell you this, but told me." I think we need to empower our teams to come to us with that information as well.
Zachary Klaassen: Yeah. Great point. That's awesome. Always a good discussion with, Ashish. Congratulations on a super initiative and thanks for joining us on UroToday.
Ashish Kamat: My pleasure. Thank you.