Patient Survey Sheds Light on Critical Communication Gaps in NMIBC Care

A recent survey revealed that patients with non–muscle invasive bladder cancer (NMIBC) in the US seek more comprehensive care conversations, calling for more open patient-provider dialogue about available treatment options.¹

The survey, conducted online by The Harris Poll on behalf of ImmunityBio among 200 adult patients in the US between September and October 2025, offers compelling insights into patients’ perspectives of NMIBC treatment and their personal experiences amid a rapidly evolving treatment landscape.

The key takeaway from the survey was a clear patient-provider communication disconnect regarding NMIBC treatment, with only 18% of patients reporting having regular discussions with their providers about the full range of procedures or treatment options at most or every visit. At the same time, the vast majority (92%) said they depend on information from their provider to guide treatment decisions, rather than external sources (eg, advocacy groups).

“This survey highlights the urgent need for patients and providers to engage in deeper, more collaborative conversations about all treatment choices for [NMIBC],” said Richard Adcock, president and CEO of ImmunityBio, in a news release.¹

Patient Preferences: A Desire for Alternatives

Another highlight from the patient responses was a desire for alternatives to intravesical chemotherapy and radical cystectomy. More than half (58%) of patients said that their provider discussed chemotherapy prior to their initial procedure or treatment, yet even more (72%) preferred chemotherapy as a last resort and wished to explore other treatment options first. On cystectomy, a great majority (89%) said they would “try anything” to avoid removal of their bladder, suggesting awareness of the invasive nature of cystectomy and the impact it has on quality of life.

Other overarching treatment priorities identified by patients include quick effectiveness in stopping or slowing disease progression and lasting duration of such positive treatment effects.

The Promise of Immunotherapy

Of particular note from the survey was the promise that immunotherapy, such as Bacillus Calmette-Guérin (BCG) therapy, brings to the majority of patients with NMIBC, addressing the concerns they expressed with chemotherapy and cystectomy. Most (89%) patients regarded the mechanistic concept of immunotherapy, described as a “treatment that enhances their body’s immune system to fight cancer,” as “cutting-edge,” with 84% believing it has fewer adverse effects compared with chemotherapy. Of patients who had received immunotherapy for NMIBC, 72% were satisfied with positive treatment effects such as cystectomy avoidance and disease-free survival, while about 66% were satisfied with the speed at which immunotherapy stops or slows disease progression.

“Immunotherapy is empowering the body’s own defenses to fight bladder cancer, offering real hope for patients who have run out of options,” Adcock added, summarizing the patient perspective.¹

These findings are consistent with patient experiences documented in the scientific literature. A study that interviewed 32 patients with high-risk NMIBC who received BCG therapy found that most patients (69%) were satisfied with BCG treatment, despite satisfaction declining with adverse effects.³ In line with the survey findings, the treatment goals of these patients included being cured and cancer-free (50%) and/or preventing cancer recurrence (34%), with nearly all patients reporting that avoiding cystectomy was important (99%).

Navigating a Changing Treatment Landscape

As one of the most common cancers worldwide, bladder cancer poses a significant global public health challenge, with NMIBC representing 75% of bladder cancer cases due to its indolent nature and high recurrence and progression rates.⁴

Over the past few decades, novel therapeutic strategies and modalities have risen to address this burden. Although BCG therapy following transurethral resection of the bladder tumor (TURBT) has proven to be an effective option, treatment failure remains a possibility, at which point cystectomy would be the next standard treatment.^4,5

Accordingly, development of bladder-sparing treatments following BCG failure is ongoing to provide noninvasive alternatives to patients that improve quality of life, some of which have shown promising tumor responses.⁵ Such therapies leverage various modalities such as immune checkpoint inhibitors, viral gene therapies, novel drug delivery systems, and targeted molecular agents.⁴

For high-risk patients who are BCG-naive, several clinical trials are also underway to explore the addition of systemic immunotherapy to intravesical BCG instillations to minimize the risk of BCG failure.⁶

With the breadth of innovations now available or in development, the survey underscores the crucial role of providers in keeping patients informed of emerging treatment options, especially those tailored to their type or stage of cancer. Ensuring patients are well-informed may foster patients’ active participation in treatment decision-making and support treatment adherence for better clinical outcomes and quality of life.

REFERENCES

1. New survey reveals non-muscle invasive bladder cancer patients seek more care conversations. News release. Business Wire. November 13, 2025. Accessed November 14, 2025. https://tinyurl.com/mr353mc7

2. Jubber I, Ong S, Bukavina L, et al. Epidemiology of bladder cancer in 2023: A systematic review of risk factors. Eur Urol. 2023;84(2):176-190. doi:10.1016/j.eururo.2023.03.029

3. Kopenhafer L, Thompson A, Chang J, et al. Patient experience and unmet needs in high-risk nonmuscle-invasive bladder cancer: Insights from qualitative interviews and a cross-sectional survey. Urol Oncol. 2024;42(3):70.e1-70.e10. doi:10.1016/j.urolonc.2024.01.013

4. Filon M, Schmidt B. New treatment options for non–muscle-invasive bladder cancer. Am Soc Clin Oncol Educ Book. 2025;45(2). doi:10.1200/edbk-25-471942

5. D'Andrea D, Mostafid H, Gontero P, et al. Unmet need in non-muscle-invasive bladder cancer failing Bacillus Calmette-Guérin therapy: A systematic review and cost-effectiveness analyses from the International Bladder Cancer Group. Eur Urol Oncol. 2025;8(1):216-229. doi:10.1016/j.euo.2024.10.012

6. Gabriel PE, Roumiguié M, Marcq G, et al. The evolving landscape of systemic Immunotherapy for Bacillus Calmette-Guérin–naïve high-risk non–muscle-invasive bladder cancer: At the edge of a tsunami? Eur Urol Oncol. 2025;8(4):1174-1181. doi: 10.1016/j.euo.2025.06.003