Barriers to BCG immunotherapy in patients with non-muscle invasive bladder cancer: experiences from Colombia

Barriers to BCG immunotherapy in patients with non-muscle invasive bladder cancer: experiences from Colombia

William Camargo-Ariza 1 , Juan P. Álzate-Granados 2 , Rodolfo Varela-Ramírez 3 , David A. Castañeda-Millán 1

1 Unidad de Urología, Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia; Grupo de Investigación e Innovación en Urología, Facultad de Medicina, Universidad Nacional de Colombia; Bogotá, Colombia; 2 Grupo de Investigación e Innovación en Urología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; 3 Unidad de Urología, Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia; 3Unidad de Urología Oncológica, Instituto Nacional de Cancerología; Bogotá, Colombia

*Correspondence: David A. Castañeda-Millán. Email: dacastanedam@unal.edu.co

Abstract

Objective: To identify the barriers to access to bacille Calmette-Guérin (BCG) treatment for non-muscle invasive bladder cancer (NMIBC) in Colombia from the perspective of urologists and patients.

Method: This observational cross-sectional study was conducted through an anonymous survey administered to urologists and patients undergoing BCG treatment in Colombia between January and June 2023 to assess their perceptions regarding this therapy. We performed univariate and bivariate analyses to determine correlations between variables of interest.

Results: A total of 83 urologists and 68 patients participated. For urologists, the reasons for excluding BCG treatment were lack of clinical indication (36.8%), unavailability of the medication (17.1%), and lack of healthcare pathways (17.1%). 82.8% stated that unavailability and problems with the dispensing of the medication are the main barriers to treatment. From the patients’ perspective, the main barriers were dispensing/delivery of the medication (35.2%), unavailability (17.6%), and lack of clinical follow-up (17.6%). 43.1% did not receive support or clinical follow-up, and 76% believe that the delivery and administration pathways of BCG need to be improved. The university status and complexity level of the hospitals, as well as the volume of patients/year treated with NMIBC, were factors correlated with BCG prescription patterns. There were differences in patients’ perceptions regarding ease of access to treatment and time between prescription and administration depending on the city where they received treatment.

Conclusions: In Colombia, there are clinical, logistical, and administrative barriers that limit adequate and timely access to BCG treatment.

Keywords: Non-muscle invasive bladder neoplasms; Intravesical drug administration; BCG vaccine

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