Why should patients collaborate with their healthcare team to make bladder cancer care decisions? Dr. Piyush Agarwal defines shared decision-making, discusses the goals of bladder cancer treatment, and emphasizes the value of clear and open communication with your care team.
Dr. Piyush K. Agarwal is the Director of the Bladder Cancer Program at the University of Chicago Medicine Comprehensive Cancer Center (UCCCC), where he also serves as Professor of Surgery, Vice Chief of Urology, and Fellowship Director of Urologic Oncology. Learn more about Dr. Agarwal.
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Transcript
Katherine Banwell:
When it comes to choosing therapy for bladder cancer, it’s essential for a patient to work with their healthcare team to determine what’s best for them. How would you define shared decision-making, and why is it so important for managing bladder cancer care?
Dr. Piyush Agarwal:
Yeah, so the issue is, there are some states of the disease where there are different options for therapy. And that is a point where ultimately the patient has to bear the burden of the disease based on the treatment chosen. Certainly we try to stress the positives of the treatment and the expected outcomes, but we also try to highlight the potential side effects. And so, it’s very important that we as providers have a really comprehensive discussion with patients of the different treatment choices available, the possible outcomes of those treatment choices, both from efficacy and from side effects.
And that’s where it’s really important to work with our patients and to really inform them, so they can make a good decision for themselves. And that’s where there are some great resources out there on the web, or there are printed materials that we can use to sort of help educate patients. Ultimately, a lot of the education comes at the consultations we have with the patients in the office prior to treatment.
Katherine Banwell:
It’s the patient and care partner and doctor and the healthcare team all working together.
Dr. Piyush Agarwal:
Yes, yes. And I think it’s not just a one-time sort of interaction. And I always try to tell my patients, “Look, take some time to review this material. Don’t need to make a decision today. Why don’t we come back and revisit this in a week? And at that point, you’ve got some more knowledge, and you might have some more questions for me after you’ve had a chance to look at this material.” We try to come up with a decision over a few interactions as opposed to one office visit.
Dr. Piyush Agarwal:
What are the treatment goals for bladder cancer?
Dr. Piyush Agarwal:
I think quality of life is probably first and foremost. That can take the form of if you are trying to preserve your bladder, are we able to leave you with a bladder that’s worth preserving? I think if you asked every patient, “Would you like to preserve your native bladder?” almost everybody would say yes; but the other issue becomes at what cost and if your quality of life is significantly impacted by repeated treatments, urinary frequency, urgency, inability to hold your urine, then sometimes the treatment choice may need to be more aggressive in order to achieve a better quality of life.
I think that is, obviously, if bladder preservation can be done while maximizing quality of life, then that would be sort of another main treatment goal for patients. And then I think if bladder preservation cannot be done, then I think trying to provide patients with an option that they can live with and still enjoy doing the things that they are doing prior to their cancer diagnosis. I think this is where, again, the discussion is important as to what are the patient’s goals. I’ve had some patients who want to rid themselves of the cancer, so they choose the most aggressive treatment, and that might mean not preserving their bladder.
And I’ve had patients who will do anything to preserve their bladder and will accept really poor urinary function, just because they want to save their native bladder. Every patient’s different. We try to work with them to maximize and prioritize the goals that are important to them.