Perception and factors affecting compliance to intravesical bacillus calmette - guerin therapy in carcinoma bladder patients: An in-depth analysis in a tertiary care-a mix method study design

ABSTRACT

Introduction and Objective: Intravesical Bacillus Calmette-Guerin (iBCG) therapy for urinary bladder cancer (UBC) is associated with poor compliance due to various psycho-social issues unique to its treatment. The objective of this study was to identify and analyse the patient's perception and the factors that affected its adherence. Method(s) This mixed-method study was conducted on UBC patients who received/received iBCG. Following purposive sampling, patients who received at least one induction and one maintenance dose were assigned to a compliant group, and who did not were assigned to the non-compliant group. The patient's quality of life was assessed using the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Semi-structured, in-depth interviews (IDI) of 35-40 minutes were conducted. The transcribed verbatim was analysed by deductive coding and content analysis. The appropriate codes, domains and themes were identified and analysed. Result(s) Demographic and socio-economic characteristics were comparable in both groups. The mean treatment expenditure was higher in the non-compliant group (1.87+/-0.75 vs 3.87+/-1.31;p=0.04). The quality of life measured was similar in both groups. IDI analysis noted that the primary reasons for non-compliance were frequent hospital commute, COVID travel restrictions, lack of knowledge, loss of daily wage, paucity at various levels in government hospitals and expensive corporate healthcare. Treatment-related severe frequency and dysuria also significantly contributed to non-compliance. Conclusion(s) Compliance can be achieved if the patients cope with the initial phase of treatment with positivity and optimism. Good symptomatic relief with proper knowledge and guidance could address the non-compliance.