Replacing surveillance cystoscopy with urinary biomarkers in followup of patients with non-muscle-invasive bladder cancer: Patients’ and urologic oncologists’ perspectives

Rashid K. Sayyid, Abdallah K. Sayyid, Zachary W A Klaassen, Karen Hersey, Hanan Goldberg, Nathan Perlis, Ardalanejaz Ahmad, Ricardo Leao, Thenappan Chandrasekar, Kamel Fadaak, Rabii Hussein Madi, Martha Kennedy Terris, Antonio Finelli, Robert J. Hamilton, Girish S. Kulkarni, Alexandre R. Zlotta, Neil E. Fleshner

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Abstract

Introduction: Urinary biomarkers are being developed to detect bladder cancer recurrence/progression in patients with non-muscle-invasive bladder cancer (NMIBC). We conducted a questionnaire-based study to determine what diagnostic accuracy and cost would such test(s) need for both patients and urologic oncologists to comfortably forgo surveillance cystoscopy in favour of these tests. Methods: Surveys were administered to NMIBC patients at followup cystoscopy visit and to physician members of the Society of Urologic Oncology. Participants were questioned about acceptable false-negative (FN) rates and costs for such alternatives, in addition to demographics that could influence chosen error rates and costs. Results: A total of 137 patient and 51 urologic oncologist responses were obtained. Seventy-seven percent of patients were not comfortable with urinary biomarker(s) alternatives to repeat cystoscopy, with a further 14% willing to accept such alternatives only if the FN rate were 0.5% or lower. Seventy-five percent of urologic oncologists were comfortable with an alternative urinary biomarker test(s), with 37% and 33% willing to accept FN rates of 5% and 1%, respectively. Forty-seven percent of patients were not willing to pay out-of-pocket for such tests, while 61% of urologic oncologists felt that a price range of $100–500 would be reasonable. Conclusions: This is the first survey evaluating patient and urologic oncologist perspectives on acceptable error rates and costs for urinary biomarker alternatives to surveillance cystoscopy for patients with NMIBC. Despite potential responder bias, this study suggests that urinary biomarker(s) will require sensitivity equivalent to that of cystoscopy in order to completely replace it in surveillance of patients with NMIBC.

Original languageEnglish (US)
Pages (from-to)E210-E218
JournalCanadian Urological Association Journal
Volume12
Issue number5
DOIs
StatePublished - May 2018

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Cystoscopy
Urinary Bladder Neoplasms
Biomarkers
Costs and Cost Analysis
Oncologists
Demography
Physicians
Recurrence

ASJC Scopus subject areas

  • Urology

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Replacing surveillance cystoscopy with urinary biomarkers in followup of patients with non-muscle-invasive bladder cancer : Patients’ and urologic oncologists’ perspectives. / Sayyid, Rashid K.; Sayyid, Abdallah K.; Klaassen, Zachary W A; Hersey, Karen; Goldberg, Hanan; Perlis, Nathan; Ahmad, Ardalanejaz; Leao, Ricardo; Chandrasekar, Thenappan; Fadaak, Kamel; Madi, Rabii Hussein; Terris, Martha Kennedy; Finelli, Antonio; Hamilton, Robert J.; Kulkarni, Girish S.; Zlotta, Alexandre R.; Fleshner, Neil E.

In: Canadian Urological Association Journal, Vol. 12, No. 5, 05.2018, p. E210-E218.

Research output: Contribution to journalArticle

Sayyid, RK, Sayyid, AK, Klaassen, ZWA, Hersey, K, Goldberg, H, Perlis, N, Ahmad, A, Leao, R, Chandrasekar, T, Fadaak, K, Madi, RH, Terris, MK, Finelli, A, Hamilton, RJ, Kulkarni, GS, Zlotta, AR & Fleshner, NE 2018, 'Replacing surveillance cystoscopy with urinary biomarkers in followup of patients with non-muscle-invasive bladder cancer: Patients’ and urologic oncologists’ perspectives', Canadian Urological Association Journal, vol. 12, no. 5, pp. E210-E218. https://doi.org/10.5489/cuaj.4922
Sayyid, Rashid K. ; Sayyid, Abdallah K. ; Klaassen, Zachary W A ; Hersey, Karen ; Goldberg, Hanan ; Perlis, Nathan ; Ahmad, Ardalanejaz ; Leao, Ricardo ; Chandrasekar, Thenappan ; Fadaak, Kamel ; Madi, Rabii Hussein ; Terris, Martha Kennedy ; Finelli, Antonio ; Hamilton, Robert J. ; Kulkarni, Girish S. ; Zlotta, Alexandre R. ; Fleshner, Neil E. / Replacing surveillance cystoscopy with urinary biomarkers in followup of patients with non-muscle-invasive bladder cancer : Patients’ and urologic oncologists’ perspectives. In: Canadian Urological Association Journal. 2018 ; Vol. 12, No. 5. pp. E210-E218.
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abstract = "Introduction: Urinary biomarkers are being developed to detect bladder cancer recurrence/progression in patients with non-muscle-invasive bladder cancer (NMIBC). We conducted a questionnaire-based study to determine what diagnostic accuracy and cost would such test(s) need for both patients and urologic oncologists to comfortably forgo surveillance cystoscopy in favour of these tests. Methods: Surveys were administered to NMIBC patients at followup cystoscopy visit and to physician members of the Society of Urologic Oncology. Participants were questioned about acceptable false-negative (FN) rates and costs for such alternatives, in addition to demographics that could influence chosen error rates and costs. Results: A total of 137 patient and 51 urologic oncologist responses were obtained. Seventy-seven percent of patients were not comfortable with urinary biomarker(s) alternatives to repeat cystoscopy, with a further 14{\%} willing to accept such alternatives only if the FN rate were 0.5{\%} or lower. Seventy-five percent of urologic oncologists were comfortable with an alternative urinary biomarker test(s), with 37{\%} and 33{\%} willing to accept FN rates of 5{\%} and 1{\%}, respectively. Forty-seven percent of patients were not willing to pay out-of-pocket for such tests, while 61{\%} of urologic oncologists felt that a price range of $100–500 would be reasonable. Conclusions: This is the first survey evaluating patient and urologic oncologist perspectives on acceptable error rates and costs for urinary biomarker alternatives to surveillance cystoscopy for patients with NMIBC. Despite potential responder bias, this study suggests that urinary biomarker(s) will require sensitivity equivalent to that of cystoscopy in order to completely replace it in surveillance of patients with NMIBC.",
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AU - Sayyid, Abdallah K.

AU - Klaassen, Zachary W A

AU - Hersey, Karen

AU - Goldberg, Hanan

AU - Perlis, Nathan

AU - Ahmad, Ardalanejaz

AU - Leao, Ricardo

AU - Chandrasekar, Thenappan

AU - Fadaak, Kamel

AU - Madi, Rabii Hussein

AU - Terris, Martha Kennedy

AU - Finelli, Antonio

AU - Hamilton, Robert J.

AU - Kulkarni, Girish S.

AU - Zlotta, Alexandre R.

AU - Fleshner, Neil E.

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N2 - Introduction: Urinary biomarkers are being developed to detect bladder cancer recurrence/progression in patients with non-muscle-invasive bladder cancer (NMIBC). We conducted a questionnaire-based study to determine what diagnostic accuracy and cost would such test(s) need for both patients and urologic oncologists to comfortably forgo surveillance cystoscopy in favour of these tests. Methods: Surveys were administered to NMIBC patients at followup cystoscopy visit and to physician members of the Society of Urologic Oncology. Participants were questioned about acceptable false-negative (FN) rates and costs for such alternatives, in addition to demographics that could influence chosen error rates and costs. Results: A total of 137 patient and 51 urologic oncologist responses were obtained. Seventy-seven percent of patients were not comfortable with urinary biomarker(s) alternatives to repeat cystoscopy, with a further 14% willing to accept such alternatives only if the FN rate were 0.5% or lower. Seventy-five percent of urologic oncologists were comfortable with an alternative urinary biomarker test(s), with 37% and 33% willing to accept FN rates of 5% and 1%, respectively. Forty-seven percent of patients were not willing to pay out-of-pocket for such tests, while 61% of urologic oncologists felt that a price range of $100–500 would be reasonable. Conclusions: This is the first survey evaluating patient and urologic oncologist perspectives on acceptable error rates and costs for urinary biomarker alternatives to surveillance cystoscopy for patients with NMIBC. Despite potential responder bias, this study suggests that urinary biomarker(s) will require sensitivity equivalent to that of cystoscopy in order to completely replace it in surveillance of patients with NMIBC.

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