Background. Hepatocellular carcinoma (HCC) treatment decisions are becoming increasingly complex as new treatment options emerge. Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient–provider discussions, improve treatment development, and inform HCC treatment guidelines. We performed a qualitative study involving patients with HCC and medical providers to assess the role of patient preferences in HCC treatment choices. Methods. Patient participants included those with HCC seen within a single tertiary care center. Provider participants involved physicians and advanced practice providers who cared for patients with HCC from a single center. Baseline and posttreatment patient interviews were conducted by trained qualitative research experts, informed by semi-structured interview guides, and analyzed using thematic analysis with pilot-tested codebooks. Summaries included a narrative description of the themes and subthemes that emerged related to each code, and illustrative quotes were used to highlight each theme. Results. The baseline interview involved 30 patients with HCC (22 of whom participated in follow-up interviews) and 10 providers who cared for patients with HCC. Patients identified factors considered when making treatment decisions included provider confidence and experience, patient prior cancer experiences, other health issues, and faith. Providers primarily discussed the role of Barcelona Clinic Liver Cancer stage, liver function, performance status, and eligibility of liver transplantation in making treatment recommendations. There was general agreement among providers that there is a need to better understand the role of patient values to improve care for HCC. Limitations. Qualitative interviews were limited to patients and providers from a single center. Conclusions. This qualitative study provided information on the variety of values considered by both patients and providers in HCC treatment decisions and the importance of considering tradeoffs of efficacy, toxicity, and inconvenience/costs. Highlights Hepatocellular carcinoma (HCC) treatment decisions are often complex and may become increasingly so as new treatment options emerge. Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient–provider discussions, facilitate patient-centered trials to develop new treatments, and inform HCC treatment guidelines. This qualitative study of patients and providers provided information on the values considered in HCC treatment decisions and the importance of considering the tradeoffs of efficacy, toxicity, and inconvenience/costs. These insights can be used to develop preference elicitation tools, perform large-scale preference elicitation surveys, and systematically assess and incorporate patient preferences into treatment decisions.

PURPOSE:To identify physical activity (PA) barriers and facilitators among Black and African American (Black/AA) cancer survivors that should be considered in future PA intervention development for this population.METHODS:A community advisory board (CAB) of Black/AA cancer survivors and patient advocates guided in-depth qualitative interviews (n = 19) that were completed via telephone using a semi-structured interview guide. Interviews were transcribed verbatim, and data were analyzed using directed content analysis to detail a report of PA barriers and facilitators during and after cancer treatment. The CAB reviewed and interpreted these barriers and facilitators to identify the final results.RESULTS:Survivors (n = 19) of nine different types of cancer completed interviews. PA barriers during cancer treatments included physical and psychological suffering. PA barriers after cancer treatments included social and environmental constraints (e.g., lack of access needed for PA, safety concerns, and competing priorities). PA facilitators both during and after cancer treatments included family support, faith, and support from other survivors. PA facilitators during treatment also included feeling better after doing PA, setting realistic and flexible goals, and gaining a sense of control of one's health by striving for PA goals.CONCLUSIONS:To increase PA among Black/AA cancer survivors, PA interventions are needed that address structural barriers, include the role of faith, leverage family support, highlight the psychological benefits of PA, and use goal setting.

BACKGROUND:Patient-reported outcomes (PRO) measures relevant to domains most important to patients with HCC who received locoregional therapies are needed to advance patient-centered research. Furthermore, electronic PRO monitoring in clinical care has been shown to reduce hospitalizations and deaths in patients with other cancers. We conducted a qualitative study among patients with HCC who recently received locoregional therapies to (1) identify common and distressing posttreatment symptoms to prioritize PRO domain selection and (2) gauge interest in an electronic PRO symptom monitoring system.METHODS:We performed semi-structured telephone interviews among adult patients who received locoregional therapies (median of 26 days after treatment) for treatment-naïve HCC at a single tertiary care center. Interviews were conducted until thematic saturation was reached. Qualitative content analysis was conducted to identify emerging themes and sub-themes.RESULTS:Ten of 26 patients (38%) reported at least 1 symptom before treatment. In contrast, all participants (n = 26) with recently treated HCC reported at least 1 posttreatment physical symptom, with the most common being appetite loss (73%), fatigue (58%), abdominal pain (46%), and nausea (35%). Most participants (77%) stated they saw potential benefits in posttreatment ePRO symptom monitoring.CONCLUSIONS:Posttreatment symptoms after HCC locoregional therapies are common and often severe. These data can inform and prioritize PRO domain selection. Patients are interested in ePRO monitoring to monitor and proactively address posttreatment symptoms. Given the clinical benefits in patients with metastatic cancers, ePRO monitoring warrants investigation in patients with HCC.

107 Background: Clinical trials are essential for developing novel cancer treatments and improving survival. However, Black women with breast cancer have higher cancer mortality rates compared to non-Black women and are less likely to be enrolled in clinical trials. This study aimed to understand barriers and facilitators to clinical trial participation among Black women with breast cancer to inform the design of a mobile health application (app). Methods: Semi-structured interviews lasting 45-60 minutes were conducted between May and September 2022 with a purposive sample of 20 Black women with breast cancer receiving care in academic and community practices in North Carolina. Participants were asked open-ended questions about their perspective on clinical trial participation. Interviews were digitally recorded, transcribed, and analyzed following a consensus coding-based thematic analysis. Results: Participants represented various age groups ranging from 33 to 76 years, breast cancer hormone receptor/HER 2 status, and stage. Several themes related to facilitators and barriers to clinical trial participation emerged from the interviews. Facilitators included prior experience with participating in clinical trials (cancer treatment, behavioral, and symptom management trials); desire to increase representation of Black women in cancer research to better understand how treatments may affect them differently; benefitting others; and potential for less intensive treatment regimens. Barriers included concern with adverse health effects; fear of new drugs and uncertain therapeutic effect; historical exploitation of Black people participating in research and medical care; lack of representation of Black people participating in clinical research; lack of clinical trial opportunities; concern with the term “trial” and being treated as a guinea pig; and concern with getting a placebo. Most participants were willing to use a mobile health app to obtain trusted information about clinical trials. Recommended content for the app included clinical trial risks and benefits, personal testimonials, link to available clinical trials, and resources to address logistical barriers such as transportation. Most participants also reported the importance of having Black people represented in their healthcare team and health messaging to improve trust in clinical trials. Conclusions: Several barriers and facilitators to clinical trial participation were identified. These findings will inform the content of a mobile health app designed to improve engagement of Black women with breast cancer in clinical trial discussions. Presence of racially representative clinicians and research staff was also noted to improve participation of Black women with breast cancer in clinical trials.

You have accessJournal of UrologyCME1 May 2022MP54-06 LONGITUDINAL HEALTH-RELATED QUALITY OF LIFE OUTCOMES IN ADULTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER RECEIVING A CHEMOABLATIVE GEL AS A PRIMARY TREATMENT (OPTIMA II: PHASE 2B, SINGLE ARM, OPEN-LABEL TRIAL) Angela Smith, Ramsankar Basak, Dana Mueller, Robert Lipman, Randall Teal, Alison Hilton, Kara Giannone, Myra Waheed, and Angela Stover Angela SmithAngela Smith More articles by this author , Ramsankar BasakRamsankar Basak More articles by this author , Dana MuellerDana Mueller More articles by this author , Robert LipmanRobert Lipman More articles by this author , Randall TealRandall Teal More articles by this author , Alison HiltonAlison Hilton More articles by this author , Kara GiannoneKara Giannone More articles by this author , Myra WaheedMyra Waheed More articles by this author , and Angela StoverAngela Stover More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002633.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low-grade non-muscle-invasive bladder cancer (LG NMIBC) is treated with transurethral resection of the bladder tumor (TURBT), which can worsen health-related quality of life (HRQOL). The trial “OPTimized Instillation of Mitomycin for Bladder Cancer Treatment” (Optima II, clinicaltrials.gov: NCT03558503) is a Phase 2b, open label, multicenter trial evaluating a nonsurgical alternative as a primary treatment. Patients receive six weekly instillations of UGN-102, a mitomycin-containing reverse thermal gel. We report on HRQOL changes at the primary endpoint of 3 months. METHODS: Of 63 patients enrolled in the Optima II trial, 44 were in the HRQOL cohort and completed quarterly questionnaires (61% men, 57% age 65+, and 89% non-Hispanic White). Longitudinal changes were evaluated using the Sign test and correlations with demographic and clinical characteristics with regression. Ten patients (23%) were interviewed and transcripts were double-coded using standard methods. RESULTS: The chemoablative reverse thermal gel did not cause decrements in patient-reported urinary symptoms, bloating/flatulence, or malaise (Figure). Sexual function mildly worsened. Demographic and clinical characteristics were not correlated with HRQOL changes. By 3 months, 31/44 (70%) LG NMIBC patients achieved a complete response (negative endoscopic examination, cytology, and for-cause biopsy). In interviews, patients appreciated a nonsurgical alternative, would recommend the gel to other patients, and would choose the gel over TURBT. CONCLUSIONS: Adults with LG NMIBC receiving a nonsurgical, chemoablative gel as a primary treatment maintained their HRQOL through 3 months, and interviewed patients would recommend the gel to other patients. A Phase 3 trial is warranted. Source of Funding: Bladder Cancer Advocacy Network Patient Survey Network Award, supported by Urogen Pharma © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e928 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela Smith More articles by this author Ramsankar Basak More articles by this author Dana Mueller More articles by this author Robert Lipman More articles by this author Randall Teal More articles by this author Alison Hilton More articles by this author Kara Giannone More articles by this author Myra Waheed More articles by this author Angela Stover More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Optima II ("OPTimized Instillation of Mitomycin for Bladder Cancer Treatment," clinicaltrials.gov: NCT03558503) was a phase 2b trial evaluating a nonsurgical alternative as a primary treatment for nonmuscle-invasive bladder cancer (NMIBC). Patients received 6 weekly instillations of UGN-102, a mitomycin-containing reverse thermal gel. This is the first study to report on patient-reported side effects of UGN-102. Materials and Methods: Sixty-three patients enrolled in Optima II from 20 sites. Of these 63 patients, 44 were in the cohort completing a quarterly patient-reported outcome measure assessing side effects. Changes in side effects were evaluated using the Wilcoxon signed-rank test. Associations of 3-month outcomes with demographic and clinical characteristics were examined with regression, controlling for baseline values. Ten of 44 patients (23%) were interviewed after the trial to understand tolerability for future patients making treatment decisions. Transcripts were double-coded using standard methods. Results: In the patient-reported outcome measure cohort (44), 61% were men, 57% aged 65D years and 89% were non-Hispanic White. UGN-102 did not cause decrements in patient-reported urinary symptoms, bloating/flatulence or malaise at the primary endpoint of 3 months. Sexual function mildly worsened. Future health worries improved. Demographics were not correlated with changes. Clinically, sexual function was correlated with new NMIBC and bloating/flatulence was associated with transurethral resection of bladder tumor within 12 months. In interviews, patients appreciated a nonsurgical alternative, would recommend the gel to other patients and would choose the gel over surgery. Conclusions: A nonsurgical, chemoablative gel (UGN-102) used as a primary treatment for NMIBC offers a more patient-centered therapeutic approach than standard treatments.