Intravesical bacillus calmette-guerin (IV BCG) treatment for bladder cancer – working toward better patient outcome

Abstract

ntroduction and objectives Intravesical Bacillus Calmette-Guerin(IV BCG) is an effective treatment for non-muscle invasive bladdercancer (NMIBC). In Hong Kong West Cluster, about 98% of bladdercancer patients who receive the IV BCG treatment after TURBT willbe referred to Geriatric Urology Center (GUC), Tung Wah Hospital. Atpresent, a regime of induction 6 doses weekly BCG instillationsfollowed by a maintenance schedule of 3 doses weekly instillations at3 and 6 months thereafter until a total 18 doses completed. Oversealiterature showed only 16% of patients who undertook BCG completedthe full course of this powerful treatment against high risk bladdercancer disease.To review the local data in patients receiving BCG in GUC and toexplore the beneficial role of nursing intervention and patient educationin the BCG treatment of these patients. Materials and methods A retrospective review of bladder cancerpatients referred from HKWC Urologists for treatment of IV BCG inGUC from January 2013 to December 2015 was conducted.Results 68 patients underwent IV BCG treatment was included inthis review. 39 patients (57%) completed the full treatment course ofBCG with 5 patients (7%) reported that medication (Panadol andPyridium) could relieve the side effect after instillation. 2 patients (3%)required 50% reduction of their BCG dose. Of the 43% (29 patients)who did not complete the treatment, it had been noted BCG sideeffects were the underlying reason for drop-out in 19% of patients. Theremaining 24% failed to complete the treatment due to cancerrecurrence, disease progression or other concurrent causes. Amongthose patients who failed completion of treatment, 23 patients agedolder than 70 years.Nursing techniques in catheterization and instillation could be one ofthe symptoms control to minimize the local or systemic side effectsfrom BCG. Nursing assessment of pain, bladder irritation withfrequency and urgency, hematuria and flu-like symptoms is imperative.Early detection and education of side effects with definitive treatment,prophylactic medication prescription after instillation and appropriatereduction of the dose of BCG could reduce the severity of side effects.Conclusion BCG treatment is an effective treatment for non-muscleinvasive bladder cancer and it causes significant local side effects. In order to improve patient outcome, nurses can contribute to limitpotential side effects through active management of symptom control,better catheterization and instillation techniques and timely patienteducation. As a result, more patients can complete the BCG treatmentand receive the maximum benefit from this bladder cancer treatment.