Patients choose certainty over burden in bladder cancer surveillance

Frits Van Osch; Duncan Nekeman; Neil Aaronson; Lucinda Billingham; Nicholas James; Kar Cheng; Richard Bryan; Maurice Zeegers

doi:10.1007/s00345-019-02728-4

Patients choose certainty over burden in bladder cancer surveillance

Frits Van Osch, Duncan Nekeman, Neil Aaronson, Lucinda Billingham, Nicholas James, Kar Cheng, Richard Bryan, Maurice Zeegers

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker.

Methods: We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, nonparametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics.

Results: Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories.

Conclusions: Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.

Original language	English
Pages (from-to)	2747-2753
Number of pages	7
Journal	World Journal of Urology
Volume	37
Issue number	12
Early online date	23 Mar 2019
DOIs	https://doi.org/10.1007/s00345-019-02728-4
Publication status	Published - Dec 2022

Bibliographical note

Funding Information:
With thanks to all participating clinicians and their staff from within the West Midlands region for their continued support: P. Cooke, K. Jefferson, H. Krasnowski, J. Parkin, B.D. Sarmah, P. Ryan, R. Bhatt, M. Foster, K. Desai, L.A. Emtage, K.W. Kadow, C. Luscombe, S. Khwaja, and A. Makar. We would also like to recognise the invaluable contribution made by the BCPP nursing, research and administrative staff to the programme: A. McGuire, C. Langford, C. Letchford, C. Slater, C. Taylor, D. Bird, G. Heritage, H. Shackleford, J. Sears, J. Maiden, J. Goodall, J. Allison, J. Hutton, J.Y. Robinson, K. Castro, L.R. Moore, L. Benson, M. Grant, R. Abid, S. Collins, T. Martin, and T. Coles. In addition, we thank R.C. Reulen for his substantial help with data management and the West Midlands Cancer Intelligence Unit for providing data on patients with bladder cancer in the West Midlands. BCPP is supported by Cancer Research UK (grant number: CRUK/05/28).

Publisher Copyright:
© 2019, The Author(s).

Keywords

non-muscle-invasive
bladder cancer
non-invasive biomarkers
sensitivity and specificity
standard gamble
Standard gamble
Non-invasive biomarkers
Non-muscle-invasive bladder cancer
Sensitivity and specificity

ASJC Scopus subject areas

Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00345-019-02728-4Licence: Creative Commons: Attribution (CC BY)

Van_Osch_et_al_Patients_choose_certainty_over_burden_in_bladder_cancer_surveillance_World_Journal_of_Urology_2019
van Osch, F.H.M., Nekeman, D., Aaronson, N.K. et al. World J Urol (2019). https://doi.org/10.1007/s00345-019-02728-4
Final published version, 620 KBLicence: Creative Commons: Attribution (CC BY)

https://link.springer.com/article/10.1007%2Fs00345-019-02728-4Licence: Creative Commons: Attribution (CC BY)

Bladder Cancer Prognosis Programme
Bryan, R.
NIHR
1/05/10 → 31/07/13
Project: Other Government Departments

Cite this

@article{62659591b8bc4bdcb8385af53401f261,

title = "Patients choose certainty over burden in bladder cancer surveillance",

abstract = "Background: Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker.Methods: We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, nonparametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics.Results: Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories.Conclusions: Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance. ",

keywords = "non-muscle-invasive, bladder cancer, non-invasive biomarkers, sensitivity and specificity, standard gamble, Standard gamble, Non-invasive biomarkers, Non-muscle-invasive bladder cancer, Sensitivity and specificity",

author = "{Van Osch}, Frits and Duncan Nekeman and Neil Aaronson and Lucinda Billingham and Nicholas James and Kar Cheng and Richard Bryan and Maurice Zeegers",

note = "Funding Information: With thanks to all participating clinicians and their staff from within the West Midlands region for their continued support: P. Cooke, K. Jefferson, H. Krasnowski, J. Parkin, B.D. Sarmah, P. Ryan, R. Bhatt, M. Foster, K. Desai, L.A. Emtage, K.W. Kadow, C. Luscombe, S. Khwaja, and A. Makar. We would also like to recognise the invaluable contribution made by the BCPP nursing, research and administrative staff to the programme: A. McGuire, C. Langford, C. Letchford, C. Slater, C. Taylor, D. Bird, G. Heritage, H. Shackleford, J. Sears, J. Maiden, J. Goodall, J. Allison, J. Hutton, J.Y. Robinson, K. Castro, L.R. Moore, L. Benson, M. Grant, R. Abid, S. Collins, T. Martin, and T. Coles. In addition, we thank R.C. Reulen for his substantial help with data management and the West Midlands Cancer Intelligence Unit for providing data on patients with bladder cancer in the West Midlands. BCPP is supported by Cancer Research UK (grant number: CRUK/05/28). Publisher Copyright: {\textcopyright} 2019, The Author(s).",

year = "2022",

month = dec,

doi = "10.1007/s00345-019-02728-4",

language = "English",

volume = "37",

pages = "2747--2753",

journal = "World Journal of Urology",

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AU - Nekeman, Duncan

AU - Aaronson, Neil

AU - Billingham, Lucinda

AU - James, Nicholas

AU - Cheng, Kar

AU - Bryan, Richard

AU - Zeegers, Maurice

N1 - Funding Information: With thanks to all participating clinicians and their staff from within the West Midlands region for their continued support: P. Cooke, K. Jefferson, H. Krasnowski, J. Parkin, B.D. Sarmah, P. Ryan, R. Bhatt, M. Foster, K. Desai, L.A. Emtage, K.W. Kadow, C. Luscombe, S. Khwaja, and A. Makar. We would also like to recognise the invaluable contribution made by the BCPP nursing, research and administrative staff to the programme: A. McGuire, C. Langford, C. Letchford, C. Slater, C. Taylor, D. Bird, G. Heritage, H. Shackleford, J. Sears, J. Maiden, J. Goodall, J. Allison, J. Hutton, J.Y. Robinson, K. Castro, L.R. Moore, L. Benson, M. Grant, R. Abid, S. Collins, T. Martin, and T. Coles. In addition, we thank R.C. Reulen for his substantial help with data management and the West Midlands Cancer Intelligence Unit for providing data on patients with bladder cancer in the West Midlands. BCPP is supported by Cancer Research UK (grant number: CRUK/05/28). Publisher Copyright: © 2019, The Author(s).

PY - 2022/12

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N2 - Background: Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker.Methods: We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, nonparametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics.Results: Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories.Conclusions: Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.

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Patients choose certainty over burden in bladder cancer surveillance

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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Projects

Bladder Cancer Prognosis Programme

Cite this