The Difference Between Surviving – and Living – with Bladder Cancer

Of the approximately 82,000 people diagnosed with bladder cancer in the US each year, many feel like their future is being defined for them – not by them (Source). They’re forced to surrender to the symptoms of the disease and side effects of treatment, in addition to significant lifestyle changes that often follow. Along the way, their daily routine, sense of independence, and physical and psychological health can seem to slip out of their control.

Despite bladder cancer's prevalence and heavy burden on quality of life, its treatment landscape has long remained stagnant.

Addressing an unmet need in bladder cancer

The majority of new bladder cancer cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), a subclassification of urothelial carcinoma where the tumor has not invaded into or beyond the muscle wall of the bladder (Source). For decades, Bacillus Calmette-Guérin (BCG) immunotherapy has been heralded as the standard of care for NMIBC. But it’s time that we acknowledge an unsettling truth: while it’s a treatment that may be easy to give, it’s not easy to receive.

BCG can cause local and systemic side effects such as fever, chills, fatigue, hematuria, and urgency, which can be especially difficult to tolerate for patients who are frail, have poor kidney function, or have other comorbidities.

On top of this, treatment success is not a given: 30% to 40% of patients are unresponsive to BCG and experience recurrence and progression (Source). Many more are unable to access BCG altogether due to the ongoing global shortages.

For these patients, the only remaining treatment option is bladder removal surgery, where a urinary division is created to help collect and store urine. This is a major abdominal procedure that comes with its own risks: about 60% of patients who undergo cystectomy will have a complication within the first 90 days of their operation (Source).

Not only is the surgery itself burdensome, but so are the conditions post-surgery.?Typically, patients face one of two options:

1)??Receive a stoma, a watertight bag worn under their clothing that continuously collects urine and needs to be emptied about 4-5 times per day and replaced every 4-5 days.

2)??Receive a neobladder, where a newly constructed bladder is joined to the ureters at one end, and the other end is connected to the urethra. Without the nerves to alert them when their bladder is full, patients may experience temporary urinary leakage. They may also need to self-catheterize their neobladder to empty it completely.

Both options are irreversible and leave a drastic impact on patients’ daily lives, from work to travel to exercise and everything in between.

Empowering patients with control over bladder cancer

The medical community must urgently shift to a patient-centric approach, prioritizing not only disease-free survival outcomes but also the holistic patient experience.

Grounded in this approach, we should pursue bladder-preserving and BCG-free treatment options that put patients in control of their bladder cancer, not the other way around.

In doing so, we hold the potential to preserve not only patients’ bladders – but also the quality of life they know and the future they’ve planned for.

What could be a more valuable pursuit?