In December 2023, using the Bladder Cancer Advocacy Network’s (BCAN’s) Patient Survey Network, we surveyed 1,507 US patients being monitored for non-muscle invasive bladder cancer (NMIBC).

Those surveyed were a reflection of the typical NMIBC population where 66% of respondents were male and the average age was 65. Patient respondees shared their experience of cystoscopy – discomfort, embarrassment, anxiety and pain - and showed a strong preference for urine-based test alternatives. At the same time, many patients were unaware of leading test options having not discussed them with their physician. Following a brief introduction to Cxbladder Monitor, the majority of patients surveyed were either willing to use Cxbladder Monitor to reduce the frequency of surveillance cystoscopy or were interested to know more about the test.

The challenge for clinicians: non-compliance

American Urological Association (AUA) AQUA Registry Data suggests that the average length of follow-up monitoring among NMIBC patients is 1.8 years. To ensure early detection of any recurrence, the AUA surveillance guideline for low risk NMIBC patients is 5 years. It’s recommended that higher risk patients continue regular scheduled cystoscopies indefinitely.

Reasons for this non-compliance will vary by individual, however the invasive nature of cystoscopy must be considered a factor. Survey participants were asked about their experience with cystoscopy:

• 42% of patients surveyed said they experienced moderate to extreme discomfort. This figure was 49% among men.
• 78% told us they had experienced some pain, with 25% saying it was moderate to “worst imaginable”.
• 24% said they had experienced moderate to extreme embarrassment.
• 56% told us they had experienced moderate to extreme anxiety. This figure was 66% among 41 to 60 year olds.

Patient respondees were thankful to have a surveillance option available, however voiced their concerns with invasive testing through the pain, discomfort, embarrassment, and/ or anxiety they experienced during the procedure.

The patient response to urine-based test options

Genomic urine tests like Cxbladder Monitor provide a non-invasive surveillance alternative that can reduce the burden of invasive testing. When asked for their views on urine-based testing for surveillance of NMIBC:

• 80% of patients surveyed rated having a urine-based testing option as moderately to extremely important.
• 82% were not aware of leading urine-based testing options.
• 80% had not discussed urine testing options with their physician.

Alongside the nature of cystoscopy, distance from clinic, the travel time required for in-person visits, is another factor that may be impacting compliance. When asked for their preference on urine-based sampling methods, 62% of patients surveyed said they preferred a test with the option of in-home sampling.

Cxbladder Monitor comes with the option of in-home sampling for US patients and can reduce the frequency of cystoscopy required in those being monitored for recurrent NMIBC.

We presented patients with a slide on Cxbladder Monitor and asked patients if they would be willing to consider use of the test to reduce the frequency of surveillance cystoscopy based on this brief introduction - 38% said yes and 51% were interested, wanting to learn more. Only 11% were not interested.

Pacific Edge’s Chief Medical Officer Tamer Aboushwareb said “The results of this survey suggest that the majority of patients currently under surveillance for recurrent disease are receptive to a new non-invasive standard of care. If applied to the right patient population, clinicians have an opportunity to dramatically reduce the burden of surveillance for recurrence in their NMIBC patients through the use of Cxbladder Monitor, simultaneously maximizing patient comfort and improving compliance with long-term monitoring. Reducing the frequency of cystoscopy required and the travel burden linked to in-clinic visits also has a societal benefit that is often unrealized.”

“As the leading bladder cancer advocacy organization in the United States, we know that patients are interested in having less invasive ways to diagnose and monitor NMIBC,” said Andrea Maddox-Smith, CEO of the Bladder Cancer Advocacy Network. “Safe, reliable and effective non-invasive surveillance options are good news for patients.”