Interview with Urologic Oncologist: What Makes Bladder Cancer Unique?
Dr. Friedlander is a urologic medical oncologist specializing in cancers of the bladder and prostate. His interests are in developing novel therapies, particularly immunotherapies, to treat urologic cancers, and studying biomarkers predictive of response and resistance to therapy. The Editorial Team at BladderCancer.net was fortunate enough to be able to interview him about his observations about patient experiences, and we are excited to share his insight with you!
Yes - bladder cancer is unique in many ways. While the bladder is not a vital organ in the same way the heart or liver is (meaning a person can live without their bladder), bladder cancer nonetheless has a tremendous and unique impact on our day-to-day life. The challenges faced by patients who undergo radiation to the bladder or removal of the bladder is unique; learning how to live with a urostomy or with some of the changes induced by radiation can be a challenge for some patients, and this is rarely faced by patients with other cancers.
Experiences unique to bladder cancer patients
There are additional treatment options like BCG or other therapy for localized bladder cancer which are given directly into the bladder and are not used in other cancers, so some of the side effects (irritation of the bladder, trouble urinating, urinary infections) are very unique to bladder cancer patients. Once metastatic, bladder cancer behaves similarly to some other cancers, particularly lung cancers, in that it often spreads to the organs, lymph nodes, and bones, and is treated with chemotherapy and immunotherapy.
New bladder cancer treatments
That said, there are a number of novel therapies that are being developed specifically for bladder cancer, taking advantage of some of the unique genomic and molecular features of bladder cancer, and these therapies are not available for patients with other cancers. Enfortumab Vedotin is an antibody-chemotherapy drug that is being tested in bladder cancer (not yet approved) but is designed to work in metastatic bladder cancer, and a number of drugs are in development that target mutated fibroblast growth factor receptor 3 (FGFR3), which is a genetic finding more common in bladder cancers than in other cancers.
Support from other survivors
I try to make sure that the patients we treat are well-informed about how bladder cancer starts and how it progresses. I think one of the major misconceptions has to do with the impact of a urostomy after bladder surgery. Many patients are understandably fearful of this and think that this will dramatically impact their quality of life and decrease their happiness. While it is undeniably a major change, many of our patients lead very active lives after bladder removal and urostomy or neobladder placement, and they can do normal activities like play sports, ski, and swim. I think this is where peer support is so crucial, and survivors can educate bladder cancer patients about quality of life in a way that most providers can't.
Understanding treatment options
I think for many patients, being able to connect and discuss their cancer diagnosis and treatment options with bladder cancer survivors is tremendously important. While physicians and providers can describe the options available for treatment and the associated risks (for example, BCG therapy for localized bladder cancer, cystectomy or radiation for muscle-invasive bladder cancer, or chemotherapy or immunotherapy for metastatic bladder cancer), very few of the providers have ever undergone these types of treatments. Connecting with other survivors who have undergone these treatments is therefore a really important resource, as it can help patients become more informed about the treatments, how they may affect a patient's quality of life, including changing routines (for example, for patients who need a urostomy after bladder removal), and other day-to-day considerations. Personally, I have had patients get a lot of benefit from talking with bladder cancer support groups and survivors as they can get an honest and deeper understanding of how each treatment might affect their lives.
Healthcare professionals are still learning
Yes, I learn new things all the time. Strategies for how to cope with a cancer diagnosis, the importance of family and friends in helping with decision-making, better understanding of the mechanisms and side effects of our therapies, and how to think about end-of-life issues for patients with advanced cancer are some of the things I feel I am still learning about, and much of this comes directly from our patients.
Have your views towards bladder removal changed since you were diagnosed?