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Dr. Merrill on coping with BCG shortages in bladder cancer


“I think being savvy about how you deal with BCG supply on the administrative side is important,” says Suzanne B. Merrill, MD, FACS.

In this video, Suzanne B. Merrill, MD, FACS, discusses the Specialty Networks Spring 2023 National Conference presentation "Bladder Cancer: Clinical & Operational Models." Merrill is a urologist with Colorado Urology in Lone Tree.


This was a panel focused on the clinical and operational aspects of having what we term as an advanced bladder cancer clinic, or ABC. This kind of comes off of our prostate cancer experience and developing an APC, or advanced prostate cancer clinic. There's a lot of movement right now in the bladder cancer space, mostly due to all the novel therapeutics and research in the field. There's a lot of humdrum, if you will, about how to wrap our heads around this evolving landscape. And so one of the big questions posed to myself, and also Tom Jayram [, MD], of Urology Associates, PC, and Gordon Brown [, DO], of Summit Health was, how have our bladder cancer clinics changed out in the private sector and large urology group practices because of this? One way these clinics have changed is because of the BCG shortage and how we navigate that and how we've dealt with supply shortages, and then also about how we are getting our clinics and staff and other providers in the practice set up to be aware, educated, and start to use some of these novel therapeutics that are coming into the field, as well as how to be more appraised and get involved in the research that's going on. In regards to the BCG shortage, one of the things I mentioned that we're doing here in Colorado Urology as part of United Urology is we've set up what I call a BCG stewardship program. This is a manner in which all patients who have new diagnoses or recurrent diagnoses of non–muscle-invasive bladder cancer, get funneled through a patient messaging portal in our EMR and get screened by me as well as my physician assistant to assess what the next steps should be in their treatment. Are they appropriate for BCG? Are they appropriate for induction vs maintenance, or should they be on another intrasvesical therapy? This is also an opportunity for us to appraise the situation and see if these patients are appropriate for a research study. It's a way for us to manage and help the providers that are in far-reaching areas of our region in Colorado. It also allows our patients to get, if you will, a consultation virtually as to what next therapeutic is best in the management of their non–muscle-invasive bladder cancer. We also talked about, with dealing with this BCG shortage, you need the clinical side of things, which that BCG stewardship helps us to do. But you also need the administration side of things in terms of making sure that you are set up to understand what your supply is to ensure that supply is continuing to come and that you're managing it appropriately. It came out in a couple other practices that they found out that they were managing supply individually in their clinics rather than as a consortium. [The latter] allows you to have better purchasing power and allocation of more BCG. So, I think being savvy about how you deal with BCG supply on the administrative side is important. We also found that it was important, as we have a lot of clinics across Colorado, that all of our people who actually head up the BCG supply are talking to each other, so they understand if one clinic is in short supply, another one might be over supplied and can move supply to another practice in the region. It seems simple, but if you've been going along with a practice model for quite some time, and you're just within your own domain, you need to really start thinking outside the box of how to better manage a drug that is a vital necessity to this disease, but certainly is in short supply for all of us.

This transcription was edited for clarity.

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