Introduction & Objectives: The purpose of our study is to investigate to which extent patients with bladder cancer on endovesical installations altered their treatment and whether there are any factors that affected their decision during COVID.
Materials & Methods: We telephone-interviewed 300 consecutive patients and recorded the following parameters: age, sex, cohabitation, region of residence, level of education, employment status, disease duration, current treatment, and presence of co-morbidities. Specific questions with predefined answer options were asked: discontinuation of the medication received, reasons that led to discontinuation, whether advice was received from a clinician or other sources, symptomatology compatible with COVID-19 infection, and a questionnaire to detect nocebo behavior. Univariate and binary logistic regression analyses were performed using 'discontinuation of therapy due to fear of infections, 'discontinuation of therapy due to lack of resources/drug shortage', and 'consultation by a clinician' as dependent variables.
Results: We interviewed 300 patients (77.3% male, mean (+- SD), age 65.4+- 12.1 years, disease duration 4.5+- 3.6 years). 45% were on BCG, 33% on Mitomycin-C, and 22% on epirubicin instillations. Collectively, 5/300 discontinued endovesical instillations due to fear of immunosuppression; all but one were on BCG treatment. Fifteen patients stopped their treatment because of a lack of resources/shortage of drug; in total, 60 patients received advice about possible modifications to their treatment. All but two were guided by a clinician. Therapy withdrawal due to fear of immunosuppression was associated with underlying pulmonary disease in univariate analysis (p=0.022), and with unemployment (OR, 95%CI: 8.13, 1.30 to 65.3, p=0.03) and pulmonary disease (OR, 95%CI: 26.7, 4.16 to 215.3, p=0.003) in regression analysis. Treatment discontinuation due to lack of resources/drug shortage was not associated with any parameter tested. For most patients (68%) the disease remained stable without any recurrence or progression on follow-up cystoscopy. Treatment discontinuation was not associated with a disease exacerbation (p=0.323). Nocebo behavior was detected in 8.5% of the patients.
Conclusions: In conclusion, the discontinuation rate due to fear of immunosuppression in our cohort was low, mostly observed in patients on endovesical BCG instillations. Special consideration should be given to patients with certain social or clinical characteristics, such as unemployment and underlying pulmonary diseases.

Treatment adherence of patients with bladder cancer undergoing endovesical instillations 2 years post-COVID-19 pandemic