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Educational Opportunities in Bladder Cancer: Increasing Cystoscopic Adherence and the Availability of Smoking-Cessation Programs

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Abstract

Cancer survivors who continue to smoke following diagnosis are at increased risk for recurrence. Yet, smoking prevalence among survivors is similar to the general population. Adherence to cystoscopic surveillance is an important disease-management strategy for non-muscle-invasive bladder cancer (NMIBC) survivors, but data from Surveillance, Epidemiology, and End Results program (SEER) suggest current adherence levels are insufficient to identify recurrences at critically early stages. This study was conducted to identify actionable targets for educational intervention to increase adherence to cystoscopic monitoring for disease recurrence or progression. NMIBC survivors (n = 109) completed telephone-based surveys. Adherence was determined by measuring time from diagnosis to interview date; cystoscopies received were then compared to American Urological Association (AUA) guidelines. Data were analyzed using non-parametric tests for univariate and logistic regression for multivariable analyses. Participants averaged 65 years (SD = 9.3) and were primarily white (95 %), male (75 %), married (75 %), and non-smokers (84 %). Eighty-three percent reported either Ta- or T1-stage bladder tumors. Forty-five percent met AUA guidelines for adherence. Compared to non-smokers, current smokers reported increased fear of recurrence and psychological distress (p < 0.05). In regression analyses, non-adherence was associated with smoking (OR = 33.91, p < 0.01), providing a behavioral marker to describe a survivor group with unmet needs that may contribute to low cystoscopic adherence. Research assessing survivorship needs and designing and evaluating educational programs for NMIBC survivors should be a high priority. Identifying unmet needs among NMIBC survivors and developing programs to address these needs may increase compliance with cystoscopic monitoring, improve outcomes, and enhance quality of life.

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Funding Support

This work was partly supported by the Michael E. DeBakey VA Medical Center Health Services Research & Development Center of Excellence (HFP90-020). The views expressed reflect those of the authors and not necessarily the views of the Department of Veterans Affairs/Baylor College of Medicine.

Additional support was provided by Baylor College of Medicine Scott Department of Urology developmental funding. DML also received support from Mentored Research Scholar Grant 06-083-01-CPPB from the American Cancer Society.

Conflicts of Interest

The authors report no financial conflicts of interest.

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Authors and Affiliations

  1. Levine Cancer Institute, Carolinas Healthcare System, 1021 Morehead Medical Drive, Charlotte, NC, USA

    Marc A. Kowalkowski

  2. Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Marc A. Kowalkowski & Nancy J. Petersen

  3. Health Services Research & Development, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Marc A. Kowalkowski, Heather Honoré Goltz & Nancy J. Petersen

  4. College of Public Service, University of Houston-Downtown, Houston, TX, USA

    Heather Honoré Goltz

  5. Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

    Gilad E. Amiel, Seth P. Lerner & David M. Latini

  6. Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    David M. Latini

Authors
  1. Marc A. Kowalkowski
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  2. Heather Honoré Goltz
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  3. Nancy J. Petersen
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  4. Gilad E. Amiel
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  5. Seth P. Lerner
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  6. David M. Latini
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Correspondence to Marc A. Kowalkowski.

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Kowalkowski, M.A., Goltz, H.H., Petersen, N.J. et al. Educational Opportunities in Bladder Cancer: Increasing Cystoscopic Adherence and the Availability of Smoking-Cessation Programs. J Canc Educ 29, 739–745 (2014). https://doi.org/10.1007/s13187-014-0649-3

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  • DOI: https://doi.org/10.1007/s13187-014-0649-3

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