Page 4 - CUA 2020_Onco_Bladder

2020 CUA Abstracts

Margaret Cancer Centre, University Health Network, University of POD-4.6
Toronto, Toronto, ON, Canada WATChmAN: Interim results of a randomized trial of virtual
Introduction: Comparative effectiveness research between trimodal surveillance vs. standard in-person care for clinical stage I
therapy (TMT) and radical cystectomy (RC) for muscle-invasive bladder testicular cancer
cancer is conflicting. Prior systematic reviews and meta-analyses in favor Robert J. Hamilton , Lauren Landoni , Kopika Kuhathaas , Peter W. M.
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of RC were mainly driven by large U.S.-based registry studies at high Chung , Philippe L. Bedard , Padraig R. Warde , Aaron R. Hansen , Tran
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risk of bias. Hence, we aimed to compare the survival among patients Truong , Ezra Hahn , Michael A.S. Jewett 1
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diagnosed with T2 bladder cancer who either initiated TMT or underwent 1 Division of Urology, Department of Surgical Oncology, Princess Margaret
RC in a Canadian population-based cohort adjusted for a wide range of Cancer Centre, University Health Network, University of Toronto, Toronto,
assumed confounders. ON, Canada; Princess Margaret Cancer Centre, University Health
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Methods: Province-wide pathology reports (April 2004 to December Network, Toronto, ON, Canada; Department of Radiation Oncology,
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2015) were linked with health administrative data to identify patients Princess Margaret Hospital, University Health Network, University of
diagnosed with T2 bladder cancer. We compared 90-day mortality and Toronto, Toronto, ON, Canada; Department of Medical Oncology,
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cancer-specific survival (CSS) between patients who initiated TMT and Princess Margaret Hospital, University Health Network, University of
patients who underwent RC by multivariable regression analysis. Effect Toronto, Toronto, ON, Canada; Techna Institute, University Health
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sizes (reference: RC) were presented as adjusted odds ratios (aOR) or Network, University of Toronto, Toronto, ON, Canada.
hazard ratios (aHR) (95% confidence interval [CI]). Support: MSH-UHN innovation fund. Meekison-Keystone-Posen family
Results: We identified 1890 patients who were diagnosed with T2 blad- fund
der cancer, of which 188 (9.9%) initiated TMT (median dose: 60 Gray; Introduction: Most guidelines recommend active surveillance (AS)
most common radiosensitizer: cisplatin; salvage RC rate: 9%) and 1702 as initial management for stage I testis cancer (TC). AS entails blood
(90.1%) underwent RC. Median followup time was 1.9 years. Ninety-day work and imaging at regular intervals requiring multiple clinic visits
mortality was significantly lower in patients who initiated TMT compared spanning five years. This is time-consuming, costly, and requires high
to patients who underwent RC (crude rate: 2.7% vs. 7%, p=0.03; adjusted compliance. To address these issues, we innovated a secure online
aOR 0.26 [0.10–0.66]). A statistically significant difference in CSS could platform, WATChmAN (Web-based virtuAl Testicular CANcer clinic),
not be observed (aHR 0.96 [0.59–1.54]). to enable asynchronous communication between patients, results, and
Conclusions: To our knowledge, this cohort study conducted in a setting physician team. This is an interim report of results.
with regionalized cancer care is the first population-based study that Methods: We conducted an RCT (NCT03360994) with patients on AS
confirms, in comparison to prior U.S.-based registry cohorts, the similar randomized to virtual (WATChmAN) vs. standard in-person care. Primary
survival outcomes between TMT and RC observed in single-center, com- endpoint is safety: loss to followup, compliance, incidence of relapse,
parative studies. However, we detected a 90-day mortality rate among delay in detection, and burden of relapse. Non-compliance represents:
patients who underwent RC that was more than twice as high as the one a) delay in visit; or b) followup visit with incomplete testing. Secondary
seen among patients who initiated TMT. endpoints include patient/physician satisfaction and cost savings.
Results: At present, 112 of a planned 144 patients are enrolled. More
patients in the virtual arm have been compliant with AS schedules (79%
vs. 66%) with shorter median compliance delays (14 vs. 17.5 days).
Fourteen patients have relapsed: eight virtual (14.3%) and six standard
(10.7%). Median time to relapse was shorter for the virtual arm (8 vs. 9.5
months), with no difference in burden of disease at relapse. Response rates
to six-month surveys were 80% and 65% for virtual and standard arms,
respectively. When asked if satisfied with their care, on the virtual arm
61% reported “extremely satisfied” and 39% “satisfied,” compared to 39%
and 57%, respectively, for the standard arm. When WATChmAN patients
were asked if the application was able to provide the same excellence of
care as in-person appointments; 84% reported “strongly agree” or “agree.”
Conclusions: Interim results suggest virtual care in stage I TC is feasible
and safe with improvements in patient satisfaction. This may serve as a
potential model for virtual care for other cancers.

S40 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)