Editorial Comment: Perceived impact on patient routines/responsibilities for surgery and a non-surgical primary treatment option in recurrent LG-IR-NMIBC: findings from the ENVISION phase 3 trial

Editorial Comment

Broadly, ENVISION is a phase 3 single arm trial evaluating the efficacy of chemoablation with mitomycin gel (i.e., UGN-102) among patients with low grade intermediate risk non-muscle invasive bladder cancer (LG-IR-NMIBC). Within this unique data opportunity, Stover and colleagues present patient perceptions of different management strategies for patients with LG-IR-NMIBC.¹ The study explores how two different treatment approaches, transurethral resection of bladder tumor (TURBT) and intravesical mitomycin gel administration, impact patients’ daily routines and quality of life. The authors conducted semi-structured interviews with 29 patients enrolled in the ENVISION trial prior to initiating UGN-102 and at 3 months following intravesical therapy (i.e., two interviews per patient).

Three main themes emerged from this study. First, patients perceived more interference in daily life, such as missing days of work, following TURBT compared to UGN-102. Next, patients perceived similar urinary symptoms between the treatment options. However, catheter-related issues appeared particularly burdensome for patients undergoing TURBT. Lastly, most patients perceived UGN-102 as less invasive, less time consuming, less painful, and would recommend UGN-102 over TURBT. Given the repetitive nature of NMIBC treatment (e.g., repeat TURBTs, multiple instillations of intravesical therapy), even small improvements in the patient experience can facilitate large gains in quality of life over the full spectrum of a patient’s care. In this context, this study is emblematic of a new strategy to improve the quality of bladder cancer care by optimizing patient reported outcomes where possible.^{2, 3}

There are several limitations to note. Patients were aware of their biopsy result during their second interview, potentially introducing bias when describing their treatment-related symptoms. In addition, by having patients compare their recent experience with UGN-102 with prior TURBT raises the possibility of recall bias. Despite these limitations, we commend the authors on their novel qualitative study, nested within a prospective trial.