What You Should Know About Your Role in Bladder Cancer Treatment and Care Decisions

Katherine Banwell:

Hello, and welcome. I’m Katherine Banwell. Today’s webinar is part of PEN’s Elevate series. The goal of these programs is to help bladder cancer patients and care partners feel educated and informed when making decisions with their healthcare team.

Before we get into the discussion, please remember that this program is not a substitute for seeking medical advice.

Please refer to your healthcare team about what might be best for you. Well, let’s meet our guest. Joining us today is Dr. Ashish Kamat. Welcome. Would you please introduce yourself?

Dr. Ashish Kamat:

Katherine, thank you so much for having me. I think efforts such as these are really, really important for what we do in the community for obviously our patients and the field. So, again, I just want to extend my appreciation. I’m Ashish Kamat. I’m a urologic oncologist at MD Anderson Cancer Center in Houston, Texas.

I’ve been taking care of patients with cancer and specifically bladder cancer for almost three decades now, which, you know, if you go back with all the developments we’ve had, really, really remarkable. So, thank you so much for having me.

Katherine Banwell:

Well, thank you so much for joining us today. To start, can you share some of the recent highlights and research and advances in research?

Dr. Ashish Kamat:

Yeah, Katherine, that’s such a broad question that we could spend two days talking about it, right? And I think that’s really good because it means there have been a lot of advances which benefit our patients and people listening to us today. There are several different ways to look at it, but I think the biggest sort of push has been, as a field, there have been a lot of advances in research that allow patients to, A, live longer, which is obviously always the goal, but B, live longer with improved quality of life. And by that, what I mean is that the advances are moving towards not just survival, which, as I said, is always key, but allowing patients as much as possible to preserve their bladder, and, of course, everything else kind of dovetails into those two broad categories.

Katherine Banwell: 

I know the ASCO meeting took place in June. What were the highlights from that meeting?

Dr. Ashish Kamat: 

So, let me sort of reset the timeline because ASCO obviously is critical, but there have been so many developments that have been coming out over the last 12 months that it was not disappointing because I don’t want to use that word, but ASCO didn’t really have any new groundbreaking things to present; it was more updates on these trickle-down advances that happened over the months. And I think that’s important because it used to be that we would have to go to one major meeting just once every 12 months and only there hear about the advances. That’s the old paradigm.

I think nowadays, there’s just so much momentum, so much going on that these reports come out at AUA, they come out at GU, ASCO, EUA, ESMO, and, of course ASCO. So, with that in mind, just because it wasn’t only released at ASCO, some of the key things were, of course, the use of systemic therapy in patients with muscle-invasive disease in a way that is agnostic to their renal function.

And by that, what I mean is the EV-pembro paradigm. Because it used to be that patients with muscle-invasive bladder cancer, as with the metastatic phase, had to get cisplatin-based (Platinol) chemotherapy, and that depended heavily on their neurologic function, their kidney function, and a lot of bladder cancer patients tend to be older with diabetes, other issues that cause renal dysfunction.

What’s really remarkable about this new paradigm is that it’s completely agnostic of their kidney function, which allows almost every patient to potentially get this life-saving therapy, and it’s very, very effective.

So, not only do we have a treatment now that has raised the bar with better efficacy, but it’s also more equitable; more patients can actually access it. So, I think that was the major advance that was really at the ASCO meeting. The other one, which really wasn’t highlighted at ASCO specifically, but like I said, it’s been coming out over the last six months, is the improvement in therapies for patients with muscle-invasive and non-muscle-invasive disease.

So, we have muscle-invasive disease once the tumor is in the muscle of the bladder, and then we have non-muscle-invasive disease, which can still be invasive; it’s just not invasive in the muscle of the bladder. And that’s when patients are struggling with multiple lines of therapy, multiple attempts to try to prevent them from getting to that muscle-invasive phase, and we’ve had a lot of advances in that as well.

Katherine Banwell: 

So, it sounds very promising. Well, before we get deeper into bladder cancer care, let’s talk about health literacy for a moment. It’s defined by the ability to find, understand, and use information for health-related decisions. Can you talk about why health literacy is essential to accessing quality bladder cancer care?

Dr. Ashish Kamat: 

My God, again, this is a favorite topic of mine and some work that I have done over many years along with many of my colleagues and especially through the International Bladder Cancer Group, which is a group of experts across the globe that come together every so often to make recommendations and educational tools for patients.

And we also partner with the World Bladder Cancer Patient Coalition, which is a global entity and, of course, the US Bladder Cancer Advocacy Network, which is very pro-bladder cancer patients and one of the largest support groups. And over the years, what we’ve found in multiple international surveys that have been done, reaching out to not just patients but their carers, and their healthcare team, the physicians, the APPs, the nurses, everyone involved, is that access to healthcare literature and literacy, as you mentioned it, is sorely lacking.

And it’s lacking not just in countries that we think it might be lacking in globally, but even in North America. It’s often reported by patients that they find it hard to access reliable information.

If they access information, they don’t know if it’s biased, if there’s any commercial bias to it, and oftentimes they don’t get pointed in the right direction by their physician. So, I think it’s very important for any patient that’s sitting in front of me to have as much information as he or she can because that’s when it’s true shared decision-making.

If I just tell a patient X, Y, Z and they have to digest it in 10, 15, 30 minutes, and then make a decision, that’s not shared decision-making. That’s just pretend shared decision-making. So, I think access to really reliable and vetted sources is very important.

Katherine Banwell: 

Well, patients and their care partners are often overwhelmed following a bladder cancer diagnosis. What advice do you give them at their first appointment?

Dr. Ashish Kamat: 

Yeah, so it really depends upon when they get their cancer diagnosis because a lot of times they get their cancer diagnosis when the biopsy results are presented to them, and it’s a shock.

So, patients don’t know they have a cancer diagnosis, and I often tell patients that once you have a diagnosis of cancer, clearly, your physician is going to give you information, so on and so forth. But just take a step back, relax, digest the information, and then go home and talk it over with your family members. You can take a day; you can take a week; it doesn’t really make that much difference. You don’t have to rush into a decision. At that point, really, most patients have a really trusting relationship with their physician, which is really good. I always recommend reaching out to the physician that gave you the diagnosis and asking for resources; ask if you can get another follow-up appointment.

Don’t just go online; don’t just start Googling things because, especially nowadays with the way AI is set up, there are a lot of hallucinations that occur and false information, not intentionally; it’s just AI hallucinations that occur.

And then after you reach out to your physician or your healthcare team, if they point you to sources that they have sort of vetted and know are reliable, that’s great; then you can go down there.

If you need to ask follow-up questions, make a list of follow-up questions. Many of these are available on the resources that I mentioned earlier, and then go back when you’re a little bit more calm. Cancer diagnosis is a huge diagnosis. I never want to make light of it. But take a step back, ask the appropriate questions, and seek the partnership that we really want you to be involved in. Because if I have a patient and their healthcare team at home, their family and loved ones, that is really involved and understands the disease process, it really helps me take care of patients and give them the best outcome.

Katherine Banwell: 

Well, are there key questions then that patients should be asking at that first visit?

Dr. Ashish Kamat: 

Once they have the diagnosis, at the next step, they should really be asking questions about: What does this mean for me? What does stage mean for me? What is grade for me? Is it life-threatening? If it is, what is the timeline to expect? If it’s not life-threatening, what’s the timeline of treatments to expect?

But more than asking these questions, I think patients need to empower themselves by providing us, their healthcare team, with their goals – their goals of what they want from their treatment. And by that, I mean, I have had patients who came and told me that, “Dr. X, Y, Z was giving me all this toxic chemotherapy and all of that and tried to save my life, but that’s not really important to me.

I don’t care if I live two years or five years, but quality of life is paramount.” On the other hand, I have had patients who tell me, “You know what? I just had a new grandkid, and I don’t care if I lose all my hair, and I lose my leg, my left arm or right arm, but I want to live for the next 10 years. I don’t care.”

So, we really need the goals of treatment, what is important to the patient, to be provided to us. So, it’s not just asking the question, but it’s also providing the information that’s important at that first visit.

Katherine Banwell: 

Yeah. Well, let’s turn to the types of bladder cancer. Can you give us some information about that?

Dr. Ashish Kamat: 

Sure. And that’s a very complicated situation. So, the way for a patient to think about types of bladder cancer is any cancer that arises in the lining of the bladder, which also includes the lining of the prostate in men, and the lining of the uterus and the kidney in both sexes; it is called bladder cancer just locally because it arises from the lining of the bladder, which is the largest lining. So, you have a tumor that arises from the bladder; all this lining is called urothelial cancer or bladder cancer. And once you have bladder cancer, what I tell patients is that it can come in two wide varieties.

You can have the low-risk cancer, and you can have the high-risk cancer. The low-risk cancer is low risk because it’s low risk to the life of the patient.

That’s the key thing. It’s not necessarily something that’s not going to come back, but it can come back. It’s low risk, it’s low-grade, it’s not the kind of tumor that penetrates the bladder, spreads, metastasizes.

And once you are low risk, it is a nuisance; it needs to be treated, but you don’t have to worry about a threat to life. And then you have the high-risk cancers.

And the high-risk cancers are the ones that are a threat to life. And by threat to life, I don’t mean immediate threat to life. They are a threat to life because they are high grade.

Even if they are noninvasive, and by noninvasive, I mean not invasive in the muscle layer, they still have the tendency to recur and potentially start invading into the bladder’s wall. And once these tumors get a hold of the bladder wall, the true muscle layer of the bladder, that’s when the aggressive treatments really sort of go to the forefront.

Bladder removal is standard, radiotherapy in some patients, because if you don’t do that on time, and the cancer metastasizes, that’s when this high-risk cancer actually is a threat to life, and there’s no cure.

Even with the best treatments we have nowadays, the median survival is around three years. It’s not five years, 10 years, and it’s gone up from about 14 months to about 30 months in the last year. So, it’s gotten better, but it’s by no means a home run.

Katherine Banwell: 

Why is an accurate diagnosis essential, and how can a person ensure they’re getting the correct diagnosis?

Dr. Ashish Kamat: 

Yeah, very good question because the accurate diagnosis is what sets the stage for everything; understanding the risks that we talked about, understanding the treatment paradigm, understanding what it involves for you as a patient. And an accurate diagnosis involves appropriate tumor biopsy, grade, and stage from the pathologist and other workups such as CAT scans or MRIs that really add to this. I think those are the questions that patients should ask their doctor: Have I undergone all the testing that I need in order to have an accurate diagnosis?

Is there anything else I need to do to get the best diagnosis? And has this tumor, which has been removed or biopsied, been assessed by an expert GU pathologist? And by that, what I mean is, I’m not implying that every patient, especially in rural parts, will have access to an expert GU pathologist because pathology is a broad field, but if there’s any doubt in the physician’s mind that, “Oh, this tumor doesn’t look right,” it’s worth sending it off somewhere else for a second opinion which can easily be done nowadays especially with digitization of slides.

Katherine Banwell: 

So, that actually leads to my next question because it’s often advised that newly diagnosed patients seek consultation with a bladder cancer specialist. So, what’s the value of getting a second opinion?

Dr. Ashish Kamat: 

It’s huge, Katherine, and the value is twofold: Number one, for peace of mind for the patient because however much the physician in front of them might be the expert, if the patient has any doubt in his or her mind that they would prefer a second opinion, they should get one.

So, even if patients come to see me and I am an expert in bladder cancer, if they would ask me, “Should I get a second opinion?” I would say, “Yes, if it makes you feel better, please do.” Because it is peace of mind. It’s that knowing that, hey, I at least got a second opinion, and the second opinion agrees with what was recommended. So, that’s one. The other one is just asking an honest question because not everybody is a bladder cancer expert. In fact, most patients are diagnosed by a general urologist. Now, we do teach general urologists, and that’s part of the urology training, how to take care of bladder cancer.

So, I’m not saying that a patient needs to make a five-hour journey and go to a major cancer center if their treating physician is comfortable with the diagnosis. But that’s an honest question to ask the physician and say, “Do you think my cancer is such that you are comfortable taking care of this, or do you, as my physician, recommend that we, not just the patient, but the physician together, get a second opinion?”

And most physicians who are taking care of patients are very honest with their information. So, if it’s a low-grade cancer that is extremely easy to treat, extremely low risk, the physician is likely to tell the patient, “You don’t really need a second opinion, but if you want to get one, please do,” or they might say, “Oh, I haven’t seen this cancer before. We definitely need a second opinion.”

Katherine Banwell: 

Dr. Kamat, would you walk us through the factors that are considered when choosing therapy for bladder cancer?

Dr. Ashish Kamat: 

Yes, absolutely. And it sort of alludes to what I mentioned earlier: the goals of treatment. So, what is the goal of treatment for a patient? Obviously, you assume patients want to live, so overall survival, best efficacy of the treatment if it’s noninvasive, invasive, metastatic. That is clearly the important factor. But there are other factors that go in too when you’re choosing the treatment.

Because you can get survival, and this is just hypothetical. You can get survival that’s five years without your bladder, or you can get survival that’s three years with your bladder in place. So, you have to inform your physician what’s really important to you. You also have to inform your physician if there are any life events that are coming up because if there’s a treatment that cannot be delayed whatsoever, we will tell you, but if you have a major life event, say a graduation coming up, you need to wait for X number of months before you get intensive therapy, there are other treatments that can be started that can give us the time safely in order to get you to do that thing.

But once that’s done, and that’s the social aspect of things, what we really look at, and what a patient should be asking their physician, is: Based on my risk category, am I noninvasive, am I muscle-invasive, am I metastatic, and within each, what is my risk category? Now, just by definition, once you are muscle invasive or metastatic, it’s automatically all high-risk, and your treatments depend upon the histology and stage of cancer.

If you’re non-muscle-invasive, then the treatments depend on the grade and stage of tumor and the risk categorization. So, it’s a very complex decision. It’s not something to be taken lightly, but those are all the things that we factor in, and a patient should be factoring in when they’re choosing treatments. And last but not least, it’s the toxicity profile, because now, for example, we have five different agents that we can use for patients that have had a nonresponse to standard immunotherapy in the bladder. And some of them are given once every three months, and they work, say, 25 percent of the time. The others are given almost every other day, and they work about 50 percent of the time.

But I’ll have patients who tell me, “You know what? Let’s try the less intense one first. If it doesn’t work, then I’ll go to the next treatment.” On the other hand, patients will sometimes say, “Throw the whole kitchen sink at me. I want the one that has the best results. I don’t mind if I have to live in the hospital.” So, that’s the other thing that we really have to factor in.

Katherine Banwell: 

What about comorbidities? What role do they play?

Dr. Ashish Kamat: 

Oh, that’s a huge role, and that’s what I mentioned earlier about toxicity. So, if a patient has certain comorbidities, we know about those, of course, and if the patient has certain issues such as cardiac dysfunction or renal dysfunction, we factor that in when it comes to the management of patients. But if there are comorbidities that are not medically visible, but the patient has trouble at home with daily activities of life, so on and so forth, that’s something the patient absolutely needs to let us know, so we can factor that in. A simple example is a patient with maybe early stages of Parkinsonism.

If we don’t see that when they’re in the office with us, we might recommend a treatment that is very dependent on manual dexterity, and the patient just can’t do it at home. So, if they can’t do it, they don’t get the treatment, and we’ve only seen them for 30 minutes, and they haven’t revealed that to us because it’s not a full-blown issue. So, it’s very important to reveal all of your comorbidities to your treating team.

Katherine Banwell: Would you share an overview of the types of therapy for bladder cancer? You mentioned immunotherapy. What else is available?

Dr. Ashish Kamat: 

Yeah, there are many different treatments for bladder cancer, and the buckets to sort of look at that are either surgical, drug-related, or radiotherapy. That’s a broad bucket to look at. And when it comes to bladder tumors, the diagnosis is confirmed by removing or accessing the tumor. So, that’s the most important surgery that any patient with bladder cancer ever goes through. And because oftentimes it’s considered a biopsy the first step, it’s not given the importance that needs to be given. The TURBT, or transurethral resection of bladder tumors, is often done by the junior-most person or someone who’s not really invested in the diagnosis.

So, that, by itself, if it’s done correctly, is a treatment. There are many tumors where if you do the biopsy resection, the patient doesn’t need any other treatment.

So, that surgery is very important. Then, we go on to adjuvant therapy for the non-muscle-invasive, which includes chemotherapy and immunotherapy, and these are treatments usually that are put in the bladder. They work in two broad categories: Chemotherapy essentially kills cancer cells that are present, and this can be delivered directly in the bladder or using certain devices that are put in the bladder that release the chemotherapy at a slower rate. And then you have immunotherapy.

In immunotherapy, the most effective immunotherapy for non-muscle-invasive bladder cancer is actually the BCG vaccine, which was developed against tuberculosis many, many years ago, but it really has the highest efficacy of any known immunotherapy for any cancer, period. It works really well on the bladder. And then there are other immunotherapies, such as gene therapies and others that stimulate local immunotherapy in the bladder for different types of cancers. Now, if you take this paradigm, you can apply it to all the stages of bladder cancer.

And you can have surgery for muscle-invasive disease where the bladder is removed, and you make a new bladder for the patient. You can have immunotherapy, which is injected into the bloodstream, again, which has really changed the management of patients with bladder cancer, and chemotherapy, either general chemotherapy or what we call smart bomb chemotherapy where they’re attached to certain antibodies and they try to hone in on the cancer. It’s not for every patient because it can have toxicity in others, as you asked earlier, but it is an option for the appropriate patient that is always discussed.

Katherine Banwell: 

When choosing a therapy, what questions should patients ask their healthcare team about a treatment plan?

Dr. Ashish Kamat: 

The first thing the patient should ask their healthcare team is: What is this therapy, what does it mean, and how long do I have to take it?

Because setting that timeline is very important. It’s very important for the patient to adhere to the schedule. It could be the best treatment in the world, but if the patient is not able to adhere to the schedule, then we have to choose a different treatment for the patient as long as there is an option. Sometimes the cancer is metastatic. We really don’t have an option because that’s the only thing that works. But so long as there are options, the treatment schedule and the patient’s ability to adhere to the schedule are very important. Obviously, understanding the goals of the treatment is important. Is this treatment meant to cure the cancer? Is it meant to put it in long-term remission? Is it periodic remission?

What’s the goal of this treatment is also very important. If a patient, for example, embarks on a journey of treatment and then there is a recurrence of tumor in the bladder, the patient might feel, “Oh, this treatment didn’t work.” Whereas we’re like, “No, it worked. It changed the recurrence from a dangerous recurrence to a recurrence that is really low-grade and means nothing in the grand scheme of things.”

But the patient needs to understand the goal upfront. And then, of course, understanding toxicity data, what are the side effects, all those as much or as little as the patient wants to know. There are some patients who love to get literature after literature on the treatment. That’s great. And some patients say, “No, just give me the overview. Just tell me in broad terms what I need to look out for and who I can reach out to if I’m having trouble on the treatment,” which is the key question to ask. A patient should not sit at home and try to Google side effects and try to deal with things on their own. They should feel free to approach their team with questions and, of course, if they’re having trouble with the treatment.

Katherine Banwell: 

People can sometimes feel like they’re bothering their healthcare team with their comments and questions. So, why is it important for patients to speak up when it comes to symptoms and side effects?

Dr. Ashish Kamat: 

So, it’s never a bother. If you’re reaching out for advice and if you’re reaching out for guidance, it’s never a bother. And the reason patients should reach out for guidance and advice is that if they don’t, then we can’t tailor the treatment, modify, or adjust the treatment to provide the best cure or result for the patient.

So, reaching out is clearly important. Now, of course, I think what you’re alluding to is the fact that some patients feel that they’re going to be a bother if they’re reaching out with minor things. But patients don’t know what’s minor. So, send the message to MyChart. Most hospitals usually will have someone that’s monitoring that. They’ll get back to you in an appropriate amount of time. But clearly, if you feel something is life-threatening, as you mentioned earlier, just go to the emergency room.

I’m not saying sit at home if you think something is life-threatening. But even if it’s a minor question in your mind, it may not be minor to the physician. But because of this perceived I’m going to be a burden thing, there are efforts underway, and I’m sure you and your audience are familiar with this, of trying to develop these AI-based responses.

I think it’s similar to what customer service is doing in other fields. It’s a little dangerous in medicine because who knows if the AI is going to hallucinate. But for common questions: I had this put in yesterday. I have a low-grade fever. What do I do? For example, those are common things that the AI responds to; so long as they are vetted, they are reasonable ways to look at it.

Katherine Banwell: 

What is the role of a care partner when someone is in active treatment?

Dr. Ashish Kamat: 

So, Katherine, define care partner, because there are so many different definitions.

Katherine Banwell: 

Well, and I think we can be pretty broad in that definition. A care partner could be a partner, a friend, a loved one, a neighbor.

Dr. Ashish Kamat: 

With that broad definition, and I’m glad you made it broad, it’s very critical because again, a patient that is going through any cancer treatment alone is, and it’s been shown multiple times, often or more often having worse outcomes as compared to someone that has a care team.

So, patients that have obviously families that are living with them, are able to come with them to appointments, takes the burden off trying to remember issues, it takes the burden off trying to make appointments, it takes the burden off trying to recall when the next treatment is due, and also, involving your network of friends and families, the emotional support and the physical support that you get is absolutely key. So, the broader the care partner network can be – and some patients don’t want to have too broad a partnership – this circle, the more people a patient involves in their care, is always better.

Because I feel that not only does it help with emotional support, but it actually helps with the receipt and the compliance of the patient with the treatment that’s been recommended.

Katherine Banwell: 

I know that patients can often feel overwhelmed, and it seems to me that it’s a good idea to have a care partner in with the patient during appointments just in case the patient is so anxious and nervous, then the care partner can maybe take notes and remember a lot of what the discussion was about.

Dr. Ashish Kamat: 

Yeah, you’re absolutely correct. And one of the questions I always ask a patient when they’re in the room with me, I say, “Is there anybody else you want to bring in the room?” Because sometimes they’ll come to the appointment with three people but only bring one in the room. I’m like, “No, anybody else you want to bring in, bring them in.” If they’re sitting alone, I will often say, “Do you have someone you want to put on the phone? Is there someone you want to have listening in because you’re absolutely right. The more people that are involved, the more people taking notes, I love it when a patient’s daughter, son, or spouse is actually writing down things.

I joke, “Are you writing a textbook, or what are you doing?” But I like it because that way you don’t forget things or sometimes misinterpret. A patient might think if somebody says, “You have X percentage recurrence,” they may think, “Oh, I’m going to die X percentage of the time.” And the person who’s taking the note can go home and say, “No, no, no, that’s not what it means.” So, it’s very important to involve your care circle in the actual physical appointment.

Katherine Banwell: 

Thank you for that advice. I’d like to get to a few audience questions that were sent in prior to the program. David wrote: I try not to worry about recurrence too much, but it’s tough. Is there anything I can do to reduce my risk of the cancer returning?

Dr. Ashish Kamat: 

Yes, absolutely. No. 1, obviously, I presume that the patient, David, is following the recommendations, but in general, when it comes to bladder cancer, and because it’s so related to the immune system and to environmental toxins, stay away from anything that’s toxic.

So, if you are smoking, don’t smoke. If you have friends that are lighting up around you, second-hand smoke is almost just as bad if not worse; stay away from that as well, and then everything that grandma told you about improving your immunity, if she did, is important. So, get your sleep – very important; exercise – important; stay away from all the processed and junk food as much as possible. I know it’s expensive, but you want to try to eat healthy as well, and clearly, exercise, immunity-building efforts, very important.

Katherine Banwell: 

Yeah, and trying to keep a positive attitude –

Dr. Ashish Kamat: 

Oh, absolutely.

Katherine Banwell: 

– while you’re going through the process.

Dr. Ashish Kamat: 

Absolutely.

Katherine Banwell: 

Kalli has a question. I’m not happy with my bladder cancer doctor. What advice do you have for finding a new doctor? I’m not near a large city, so I don’t have many options.

Dr. Ashish Kamat: 

Yeah, that’s a difficult question, and I have patients sometimes ask me that too, saying, “I’m not happy with the doctor who’s taking care of me.

But you’re too far away from me to come and see unless it’s once every other month or something like that.” And my response usually is, “Well, if you don’t like your doctor, why is that?” If it’s purely because you think that they’re not good at what they’re doing because that’s not their specialty, and you don’t mind them as a person, then just ask them, “Hey, who else would you recommend that is more specialized?” But if you just don’t have a good relationship with that physician, ask your family doctor because family doctors usually are taking care of patients with multiple cancers.

And they know based on feedback from their patients who’s a good doctor in town and who’s not, and, of course, if your family doctor is also someone you don’t like, then that’s a little bit hard. But then you can go to resources such as BCAN and others and their patient portals, which are completely, I guess, firewalls, so I don’t even get in. But I’ve heard from patients that they’re talking about who’s a good doctor in this area and that area, so you can get some recommendations like that. What I don’t want people to rely on at all are Google reviews and these Yelp reviews and things.

Because just like with restaurants, a lot of practices, and I’m not blaming anyone, but they are paid reviews. So, I wouldn’t trust these online reviews, but just get information from sources you trust.

Katherine Banwell: 

Thank you so much for your thoughtful responses. As we close the program, what would you like to leave the audience with? Are you optimistic about the future of bladder cancer care and treatment?

Dr. Ashish Kamat: 

Absolutely. I’m extremely optimistic. This is a great time to be in the bladder cancer field both as a researcher, a caregiver, and obviously, you never want to have a diagnosis. But if you have a diagnosis, it’s also a great time to be in bladder cancer because things have improved and changed so much, just in the last 12 months, that it’s remarkable. It’s not night and day because we want to get to a point where nobody ever dies from their bladder cancer, but we’ve gotten to a point that is fairly close to allowing patients to have long life and good quality of life even with a diagnosis of bladder cancer. So, absolutely, optimistic.

Katherine Banwell: 

Well, that’s great to hear, Dr. Kamat. Thank you so much for joining us today. We really appreciate it.

Dr. Ashish Kamat: 

My pleasure, thank you for having me.

Katherine Banwell: 

And thank you to all of our collaborators. To learn more about bladder cancer and to access tools to help you become a proactive patient, visit powerfulpatients.org. I’m Katherine Banwell. Thanks for joining us. That was such great information. We covered so much.