Bladder-sparing radiotherapy for muscle-invasive bladder cancer: a survey of providers to determine barriers and enablers

Background To understand barriers and enablers to use of curative-intent radiotherapy (RT) for muscle-invasive bladder cancer using the Theoretical Domains Framework (TDF). Methods Canadian urologists, radiation oncologists (ROs) and medical oncologists (MOs) participated in a web-based survey to assess barriers and enablers to use of RT. Survey questions were thematically mapped to TDF domains. Logistic regression was used to identify TDF domains associated with high referral/use of RT. Results 64 urologists, 29 ROs and 26 MOs participated. Participants reported comparable survival at five years with cystectomy (51%) and RT with concurrent chemotherapy (50%). Despite this, participants reported low RT referral/treatment rates: Urologists referred a median of 2/10 patients to RO; ROs treated a median of 5/10 patients referred; and MOs referred a median of 2/8 patients not referred to RO by urology. Among urologists, the TDF domains ‘beliefs about consequences’ (OR = 8.1, 95% CI 1.5–44.9), 'social and professional role’ (OR = 11.2, 95% CI 2.3–53.6) and ‘environmental context and resources’ (OR = 5.9, 95% CI 1.5–23.3) were associated with higher rates of RO referral. Conclusions We have identified factors associated with referral for RT among patients with bladder cancer. These factors should be addressed as part of a concerted effort to increase utilization of RT.