Patients with bladder cancer prioritize survival over adverse events

In this interview, Angela B. Smith, MD, MS, vice chair of academic affairs and a professor of urology at the University of North Carolina, Chapel Hill, discusses a discrete choice experiment designed to understand the treatment preferences of patients with muscle-invasive bladder cancer (MIBC).¹ The study recruited approximately 200 patients in the United States to explore how they value various treatment attributes, particularly in the context of emerging systemic therapies.

The findings revealed that patients prioritized improvements in overall survival and reductions in cancer recurrence at 5 years over all other treatment factors, including adverse events and complications. When treatment outcomes were equal, most patients preferred bladder-sparing approaches rather than undergoing a cystectomy. However, when surgery offered a clear efficacy advantage, many were willing to accept greater risks and adverse events for the potential survival benefit.

Smith emphasized that patients showed a high tolerance for treatment-related adverse events when these were linked to increased survival or reduced recurrence risk. Although this result aligned with her clinical experience, the study provided quantitative evidence confirming that patients value longevity and disease control above comfort or short-term quality-of-life concerns.

Another significant finding was related to shared decision-making. Approximately 20% of patients reported a gap between their personal treatment preferences and whether those preferences were considered during consultations with their health care providers. This suggests that, despite growing emphasis on patient-centered care, communication and preference elicitation remain inconsistent in clinical practice.

Smith interpreted patients’ willingness to accept adverse events as reflecting both physical and emotional motivations—a deep desire to eliminate cancer and regain a sense of freedom from the disease. Overall, the study highlights the need for clinicians to better integrate patient preferences into treatment planning and reinforces that survival outcomes remain the dominant factor in MIBC treatment decisions.

REFERENCE

1. Smith AB, Gore JL, Chisolm S, et al. Muscle-invasive bladder cancer treatment selection in an emerging treatment era: A patient preference study. Urology. 2025 Aug 12:S0090-4295(25)00767-8. doi:10.1016/j.urology.2025.08.013