Bacillus Calmette-Guérin utilization and treatment patterns in Chinese patients with non-muscle invasive bladder cancer: insights from a national survey of urologists

To determine characteristics of Chinese patients with non-muscle-invasive bladder cancer (NMIBC), Bacillus Calmette-Guérin (BCG) therapy utilization patterns, and factors impacting physician treatment decisions. This national survey of urologists specializing in bladder cancer treatment in China was conducted across a representative sample of hospitals and regions of differential economic development. An initial qualitative, interview-based stage including 22 urologists was performed to inform a subsequent, quantitative questionnaire-based stage with 300 urologists. Here, we report the quantitative results. Urologists reported 71.7% of their patients with bladder cancer diagnosed/treated within the last year had NMIBC. 36.8% of these Chinese patients with NMIBC seen by the urologists in the last year had de novo disease, 23.4% had recurrent disease, and 39.8% were attending for follow up. According to the urologists, patients had a median age of 59.6 years and 72.7% were male. Urologists (>80%) considered tumor stage and grade to be the most important factors for risk stratification. Despite urologists agreeing that BCG was more effective than chemotherapy in preventing recurrence and metastasis (88.0% and 80.3% of urologists, respectively), BCG was recorded by the urologists to only be given to 27.3% of eligible patients with NMIBC, with BCG reported to be more commonly prescribed in higher risk categories. Urologists reported that BCG was mostly given as monotherapy and at a dose of 120.0 mg in patients with newly diagnosed (97.7% and 72.3%, respectively) and recurrent (96.2% and 73.7%, respectively) NMIBC. Recurrence frequency and risk level/tumor node metastasis (TNM) stage were reported by 85.7% of urologists as the most important factors for selecting BCG, whereas supply and high pricing were reported to affect the continuation of BCG treatment (by 88.7% and 87.7% of urologists, respectively). These findings will deepen the understanding of patient flow and disease management for NMIBC to inform clinical practice and support the future direction of BCG and novel combination therapies.