Ep. 69 Managing Intravesical Therapy Toxicities in Bladder Cancer with Dr. Meredith Donahue and Mary Dunn, NP

Ep. 69 Managing Intravesical Therapy Toxicities in Bladder Cancer with Dr. Meredith Donahue and Mary Dunn, NP

How can clinics minimize toxicity and maximize outcomes in intravesical bladder cancer treatment? In this episode of BackTable Urology, host Dr. Vignesh Packiam talks with nurse practitioners Mary Dunn (UNC) and Meredith Donahue (Vanderbilt) about how advanced practice providers (APP) workflows and hands-on management are transforming care for non-muscle-invasive bladder cancer. The discussion highlights innovative strategies for symptom management, patient education, catheter techniques, and streamlined operational protocols across both established and emerging intravesical therapies. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 04:25 - Non Drug Symptom Tips 09:39 - Day Of Treatment Clearance 14:50 - Post Treatment Triage 20:36 - Treatment Fatigue Strategies 24:48 - Pelvic Floor And IC Tools 27:33 - Teamwork Final Pearls --- More about this episode They share individualized pharmacologic and non-pharmacologic approaches for managing lower urinary tract symptoms, such as NSAIDs, anticholinergics, beta-3 agonists, Pyridium, timed voiding, avoidance of irritants, and constipation management. The episode covers patient education resources from the Bladder Cancer Advocacy Network (BCAN), catheterization techniques tailored to patient needs, and a gravity installation method to reduce spasms. The conversation also reviews day-of-treatment clearance and triage protocols, operational considerations for new agents like Enlexo, Adstiladrin, and gemcitabine/docetaxel, as well as financial workflows that prevent drug wastage. Additional topics include managing cumulative bladder toxicity, pelvic floor PT, addressing treatment fatigue, and integrating multifactorial evaluation and exercise into patient care. --- Resources Bladder Cancer Advocacy Network (BCAN) Basic Handbook & Patient Resources https://bcan.org/bladder-cancer-basics-handbook/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 68 Metastatic Pancreatic Cancer: Treatment Options & Trials with Dr. Dawood Findakly

Can the latest therapies, lessons from clinical trials, and a focus on emotional support improve outcomes for patients with metastatic pancreatic cancer? In this BackTable Tumor Board episode, GI medical oncologist Dr. Greg Botta and medical oncologist Dr. Dawood Findakly discuss current treatment options, the importance of emotional support, and strategies for overcoming barriers such as insurance delays. They highlight the value of personalized care, from diagnosis and staging scans to tumor markers, tissue biopsy, and genomic profiling, as well as the expanding role of clinical trials and targeted therapies. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:57 - Workup and Biopsy in Metastatic Pancreatic Cancer 07:33 - Approach to Care for Metastatic Patients 10:39 - Managing Symptoms Early and Personalizing Therapy 16:52 - Assessing Combination Chemo and Clinical Trials 22:30 - Discussing Alternatives with Patients 28:19 - Measuring Treatment Response 32:51 - Emerging Role of Liquid Biopsy 35:34 - RAS Revolution: Oral Pill vs. Chemotherapy 40:49 - Wrap Up --- More about this episode The doctors cover common patient presentations, early management of complications, and the rationale behind systemic chemotherapy choices and regimen selection. They discuss practical methods for monitoring response to treatment, the growing access to clinical trials, including the promise of KRAS/RAS-targeted oral therapies, and the critical role of ongoing communication, psychological support, and individualized care planning. The episode offers insights on integrating palliative care, supporting patients through side effects, and tailoring conversations around prognosis and quality of life. --- Resources PANThEON Study https://pubmed.ncbi.nlm.nih.gov/41318310/ RAS Revolution https://www.asco.org/about-asco/press-center/multi-selective-ras-inhibitor-nearly-doubles-survival-pancreatic-cancer --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 67 Bladder Cancer Risk Stratification: Best Practices with Dr. Sunil Patel and Dr. Kristen Scarpato

Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 01:02 - Risk Stratification 07:22 - Upstaging to High Risk 10:06 - Calculators and Patient Education 15:22 - Specific Tests Use Cases 18:50 - Conflicting Biomarker Results 21:36 - Adjunct Tests and Counseling 24:03 - Recurrence After Chemo Next Steps 27:01 - Escalation Deescalation Balance 32:48 - Future Research Priorities 35:43 - Biology Based Risk Stratification 38:03 - Clinical Pearls and Wrap Up --- More about this episode The conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management. --- Resources The Memorial Study https://www.mskcc.org/cancer-care/clinical-trials/19-288 The BRIDGE Study https://www.nejm.org/doi/full/10.1056/NEJMoa1501035 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 66 Managing Complications in Pancreatic Cancer with Dr. Zach Berman and Dr. Rebekah White

How do seasoned clinicians navigate the complex web of complications that accompany pancreatic cancer? In this episode of BackTable Tumor Board, Drs. Greg Botta, Rebekah White, and Zachary Berman discuss real-world strategies for managing pain, digestive complications, and the many challenges patients face. They explore multidisciplinary approaches, emphasizing the importance of tailored pain management, careful use of enzyme supplementation, and anticipating both surgical and medical risks, especially after procedures like the Whipple. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:36 - Interventional Radiology Approach to Pain Relief 05:37 - Nerve Blocks and Neurolysis for Treatment 09:05 - Expectations for Post-operative Recovery 10:46 - Whipple Anatomy and Side Effects 13:49 - Clot Prevention After Surgery 19:11 - Managing Nutritional Challenges and Gastric Outlet Obstruction 24:37 - Treating Malignant Ascites 29:54 - Mental Health Support for Pancreatic Cancer Patients 31:16 - Setting Expectations When Communicating with Patients 39:41 - Stent Choices and Sequencing --- More about this episode The conversation covers classifying and treating pain (visceral, neuropathic, somatic, and existential), multimodal and non-opiate therapies, and targeted nerve blocks for symptom relief. The doctors address nutrition and cachexia, strategies for managing post-surgical clotting risk, and the use of stents and interventional radiology to restore digestive flow. They also highlight the need for psychosocial support, exercise to combat fatigue, and streamlined team communication for standardized, patient-centered care. The episode wraps up with practical advice on setting patient expectations, troubleshooting persistent symptoms, and leveraging clinical trials and multidisciplinary expertise. --- Resources CASSINI Study https://pmc.ncbi.nlm.nih.gov/articles/PMC7476843/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 65 Navigating Shared Decision-Making in Bladder Cancer Treatment with Dr. Kelly Bree, Dr. Meredith Donahue, and Dr. Saum Ghodoussipour

What matters most to patients with non-muscle invasive bladder cancer (NMIBC)? In this episode of BackTable Urology, Dr. Kelly Bree, Dr. Saum Ghodoussipour, and Meredith Donahue, N.P., join host Dr. Vignesh Packiam to discuss the power of shared decision-making across the NMIBC spectrum. They explore risk-adapted treatment selection, when to escalate or de-escalate therapy, and how to navigate conversations about recurrence risk, treatment burden, quality of life, and the possibility of cystectomy. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 01:55 - Second Opinions and Patient Counseling 06:08 - Intermediate Risk Stratification 12:13 - Treatment Options for Intermediate Risk NMIBC 16:20 - BCG and Alternative Treatments for High Risk NMIBC 26:49 - Options for BCG-Unresponsive NMIBC 31:42 - Sequencing and Cystectomy 37:03 - Financial and Time Toxicity 41:08 - Biomarkers and ctDNA 44:04 - Future Trials and NMIBC Innovations --- More about this episode They also review emerging therapies such as ZUSDURI, the evolving role of intravesical treatments, and the promise of biomarkers and ctDNA for personalized care. The discussion covers practical strategies for patient counseling, key updates to clinical guidelines, and a preview of innovations shaping the future of NMIBC management. --- Resources Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial: https://pubmed.ncbi.nlm.nih.gov/41571573/ Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non–Muscle-Invasive Bladder Cancer https://ascopubs.org/doi/10.1200/JCO-25-01324 CIRCULATING TUMOR DNA AS A BIOMARKER FOR UPSTAGING AND ADVERSE PATHOLOGY IN HIGH-RISK NON–MUSCLE-INVASIVE BLADDER CANCER: https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.09 Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomy https://pubmed.ncbi.nlm.nih.gov/41843048/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app