背景:在2023年,在美国,估计有82,290名个体被诊断出患有膀胱癌。对于肌肉浸润性膀胱癌(MIBC),美国泌尿外科协会建议提供根治性膀胱切除术和以顺铂为基础的新辅助化疗.然而,患者越来越多地要求替代疗法。
目的:描述影响根治性膀胱切除术联合顺铂新辅助化疗(NAC+RC)选择的因素,根治性膀胱切除术单一疗法(RC),或三联疗法(TMT)在MIBC患者中。
方法:个人,对18名在北卡罗来纳大学接受MIBC治疗的成年人进行了半结构化电话采访,从三个治疗组中招募六名患者:1)NAC+RC,2)RC,3)TMT。使用QSRNVivo对访谈转录进行定性分析,提取主要主题和子主题。患者还完成了共享决策问卷(SDM-Q-9;范围0-100)。
结果:关注生存和风险,生活质量,患者对参与的不同偏好影响了决策过程。关注周围的性功能,膀胱保存,尿路造口袋将病人推向TMT。总体上观察到高水平的共同决策,SDM-Q-9得分为95(IQR89-100)。接受TMT的患者报告的SDM-Q-9中位数最高(97,IQR94-100),而仅接受根治性膀胱切除术的患者最低(66,IQR37-96)。
结论:MIBC患者描述了一个多方面的治疗决策过程,突出关键影响,关注,和未满足的需求。了解此过程可以帮助解决误解,并使治疗选择与患者目标保持一致。医生可以利用这些见解参与共同决策,最终改善患者体验和结果。
BACKGROUND: In 2023, an estimated 82,290 individuals were diagnosed with bladder cancer in the United States. For muscle-invasive bladder cancer (MIBC), the American Urological Association recommends offering radical
cystectomy with cisplatin-based neoadjuvant chemotherapy. However, patients are increasingly requesting alternative treatments.
OBJECTIVE: To describe factors influencing selection of radical
cystectomy with cisplatin-based neoadjuvant chemotherapy (NAC + RC), radical
cystectomy monotherapy (RC), or tri-modality therapy (TMT) among patients with MIBC.
METHODS: Individual, semi-structured phone interviews were conducted with 18 adults who underwent MIBC treatment at the University of North Carolina, recruiting six patients each from three treatment groups: 1) NAC + RC, 2) RC, and 3) TMT. Interview transcriptions were qualitatively analyzed using QSR NVivo, with major themes and sub-themes extracted. Patients also completed the Shared Decision-Making Questionnaire (SDM-Q-9; range 0-100).
RESULTS: Concern for survival and risks, quality of life, and varied patient preferences for involvement influenced the decision-making process. Concern surrounding sexual function, bladder preservation, and urostomy bags drove patients towards TMT. High levels of shared decision-making were observed overall, with a median SDM-Q-9 score of 95 (IQR 89-100). Patients undergoing TMT reported the highest median SDM-Q-9 score (97, IQR 94-100), while those receiving radical
cystectomy alone had the lowest (66, IQR 37-96).
CONCLUSIONS: Patients with MIBC described a multifaceted treatment decision-making process, highlighting key influences, concerns, and unmet needs. Understanding this process can help address misconceptions and align treatment choices with patient goals. Physicians can use these insights to engage in shared decision-making, ultimately improving patient experiences and outcomes.