OBJECTIVES : Given the limited evidence to support the use of adjuvant chemotherapy and lack of options for cisplatin-ineligible patients, the treatment landscape for adjuvant treatment of muscle-invasive urothelial cancer (MIUC) may change with the potential introduction of immuno-oncology treatments as adjuvant treatment following radical resection. With the anticipated addition of treatment options, it is important to better understand the factors that matter most to patients to facilitate shared patient-physician decision-making.

METHODS : Semi-structured telephone interviews were conducted in the US with 12 patients diagnosed with MIUC, who underwent radical resection within the past 18 months, and 4 physicians (3 oncologists, 1 urologist) to understand factors that influence adjuvant treatment decision-making. Two oncologists and 3 patient advocates provided input on the interview guide. The interview guide focused on factors influencing choice of adjuvant treatment for MIUC. Participants provided importance ratings for selected adverse events (AEs) in adjuvant treatment. Transcripts of the interviews were coded using MaxQDA software to identify key themes emerging from the data.

RESULTS : Although two-thirds of the patients were not informed of their risk status after surgery, they emphasized the importance of preventing cancer recurrence. A minimum of a 2-month difference in disease-free survival can be a meaningful benefit to patients; however, half noted that increased disease-free survival would need to be balanced with quality of life and duration of AEs. Physicians and patients rated the following adverse events as being 5 or higher on a 10-point importance scale: nausea, vomiting, fatigue, infection, diarrhea, and a serious adverse event that may require hospitalization. Physicians noted that patients prefer less frequent dosing. Travel time, cost, and access to oncologists may be treatment barriers.

CONCLUSIONS : This research identified attributes influencing adjuvant treatment choice among patients with MIUC. Patients acknowledge there is a benefit-risk tradeoff between disease-free or overall survival and AEs.