Abstract
Introduction and aims: Intravesical Bacillus Calmette–Guerin (BCG) therapy is the cornerstone of superficial bladder cancer (SBC) management in the USA, and although uptake of usage in the UK has been slower, there are indications that finally British urologists are becoming enthusiastic about it. There have been no formal surveys on the use of BCG for SBC in the UK nor do we know the indications for which it is used. Finally, whilst maintenance therapy is becoming accepted treatment for high risk SBC patients in the USA and mainland Europe, knowledge about the views of British Urologists in this area is sparse. Our purpose was, therefore, to conduct a survey of practising consultant urologists who are members of the British Association of Urological Surgeons (BAUS) in order to answer all of these questions.
†Present address: Department of Urology, Orchard House, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK. Tel.: +44-1924-213639. Fax: +44-1924-212921. E-mail: [email protected]
Methods: A questionnaire was sent to all consultant urologists in the UK and the Irish Republic enquiring about the indications for use of BCG (i.e. primary and maintenance), the type of BCG strain, number of treatments per cycle and the main areas of interest of the responding clinicians.
Results: Sixty two percent (299/476) of the questionnaires were returned. Ninety-five percent of the respondents used intravesical BCG. Among the respondents using BCG, 89% used it as a first-line therapy for carcinoma-in-situ (CIS), 62% for G3pT1 disease, 60% for G3pTa and 54% for refractory G1/G2pTa/1 transitional cell carcinoma. Twenty-seven percent of respondents were unaware of the strain they used. Fifty-three percent of consultants recommended maintenance therapy of which 49% used it in case of CIS and 27% in patients with G3pT1/Ta tumours. Fifty-nine percent of those consultants recommending maintenance followed the Southwest Oncology Group regime. There were statistically significant differences in the overall usage of BCG as a first line therapy in CIS, in the usage of BCG for G3pTa/T1 disease and also in the use of maintenance BCG for G3pTa/T1 tumours amongst uro-oncologists and non-uro-oncologists (p<0.05).
Conclusions: This survey provides useful insights. As perhaps expected, the majority of clinicians use BCG as a first-line therapy for CIS. A quarter did not know the type of strain in use in their centres, which may suggest that their involvement in the treatment is peripheral. There seems to exist a difference in the pattern of BCG usage among uro-oncologists and non-uro-oncologists. Despite the debate about the use of maintenance therapy more than half of the British Urologists who responded to this survey would recommend the use of it. The latter point has major financial and resource implications, and there could be a case for issuing guidelines.
Acknowledgements
We would like to thank Cambridge Laboratories for their financial support of this project and the many urologists who kindly completed and returned the questionnaires. We would also like to thank Mr Andy Scally, Lecture, School of Health Studies, University of Bradford for his help with statistical analysis of the data.
Notes
†Present address: Department of Urology, Orchard House, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK. Tel.: +44-1924-213639. Fax: +44-1924-212921. E-mail: [email protected]
‡http://baus.org.uk/Oncology/files/1999finalanalyses.pdf