OBJECTIVES : Non-muscle invasive bladder cancer (NMIBC) frequently recurs or progresses even after the treatment with standard therapy of Bacillus Calmette-Guerin (BCG). Treatment options are limited for patients who are ineligible or unwilling to undergo cystectomy. The study aims to report on patient characteristics and treatment patterns in BCG-treated NMIBC patients in real world practice.

METHODS : An Institutional Review Board approved web-based chart review study was conducted with physicians recruited from panels who were board-certified, actively practicing urologists and oncologists, each providing three to five patient charts. Eligible charts had to meet one of the following criteria: received BCG treatment, experienced refraction to, intolerance to, or relapse after adequate BCG, as defined by the physicians. Data were collected on diagnosis, treatment, and outcomes. Comparison of descriptive statistics between groups were tested for statistical significance at 95% confidence.

RESULTS : Charts for 415 patients were collected from 73 urologists and 21 oncologists. The cohort had a mean age of 67 years, 77% male, 47% Medicare, and 30% fully employed. In this patient cohort, almost all patients (94%) received BCG but only 39% received six or more installations in the first induction, around 29% repeated BCG after induction. About 15% patients received maintenance BCG therapy. Tolerability/side effects, dosing frequency are cited as the top reasons for not completing BCG. About 20% received chemotherapy post-BCG. Only 11% of all patients received a cystectomy. Physician-reported reasons for additional therapies post-BCG were disease recurrence (34%) and high-risk classification (28%). Physicians cited a “wait and watch” approach for over 30% of their patients after first BCG induction.

CONCLUSIONS : Most BCG-treated NMIBC patients fail to receive adequate BCG. Cystectomy rate is low after BCG. Future research and better treatments are needed to improve patient outcomes in this population.