Understanding Patient Priorities in Bladder Cancer Treatment

As treatment options for muscle-invasive bladder cancer (MIBC) continue to evolve—with immunotherapy and bladder-sparing protocols reshaping the landscape—a new study brings a crucial voice into the conversation: that of the patient.

Conducted as a nationwide preference study, the findings underscore a strong desire among patients to preserve their bladder, but not at the cost of reduced survival or earlier recurrence. Most strikingly, the study reveals a readiness among patients to tolerate significant treatment-related side effects if the reward is a meaningful gain in long-term outcomes.

In this discrete-choice experiment, 202 U.S. patients with self-reported MIBC were surveyed to determine how they weigh the tradeoffs of available and emerging systemic therapies, particularly in the context of radical cystectomy versus bladder-sparing approaches. The study, which also included fixed-choice scenarios and validated measures of shared decision-making satisfaction, offers a rare and detailed glimpse into the values driving patient preferences during a critical phase of cancer care.

At the heart of the study was a central tension familiar to many oncologists and urologists: the balance between oncologic control and quality-of-life considerations. While bladder preservation emerged as a strong preference, efficacy—specifically five-year overall survival and time until cancer recurrence—clearly took precedence. Respondents consistently prioritized treatments that offered the best chance of long-term survival, even when those options came with increased risks of adverse events or more intensive treatment regimens.

Notably, patients showed a high level of risk tolerance in exchange for improved efficacy. Across the hypothetical scenarios, participants were willing to accept increasing levels of treatment-related toxicity in order to gain even incremental improvements in five-year survival—a finding that challenges assumptions about patient aversion to aggressive therapy.

One particularly revealing scenario compared two fixed treatment profiles: neoadjuvant chemotherapy alone versus a more aggressive approach combining neoadjuvant chemotherapy with perioperative immunotherapy, both followed by radical cystectomy. Nearly 75% of patients favored the latter, suggesting that patients are not only aware of emerging combination therapies but are also open to complex, multimodal treatment strategies when they perceive a clear benefit.

The results also highlighted an area for improvement in patient-provider communication. Nearly one in five participants disagreed with the statement, “My doctor asked me which treatment option I prefer,” according to the Shared Decision Making Satisfaction Questionnaire (SDM-Q-9). While most patients expressed satisfaction with the overall decision-making process, this gap suggests that shared decision-making in MIBC is still not fully realized in clinical practice.

In the context of a rapidly expanding treatment landscape—including bladder-preserving chemoradiation, immune checkpoint inhibitors, and personalized therapeutic sequencing—this study reinforces the need for clinicians to bring patients into the conversation early and often. Preferences are not monolithic, but this data suggests many patients are more aggressive and efficacy-focused in their treatment priorities than is sometimes assumed.

The findings also support the integration of structured decision-making tools and patient education resources into oncology and urology clinics, especially as novel treatments continue to reshape standard-of-care algorithms. Understanding what matters most to patients—whether that’s survival, organ preservation, or minimizing toxicity—can improve satisfaction and alignment between therapeutic intent and patient values.

Ultimately, this study adds nuance to the evolving conversation around MIBC care. For clinicians, it serves as both a validation and a challenge: to recognize that patients are willing to take risks for survival, and to ensure that those decisions are made in partnership, not in a vacuum. As treatment becomes increasingly personalized, so too must the decision-making process.