Quantifying time and financial toxicity of travel for intravesical chemotherapy: Rationale for in-home delivery of bladder cancer treatment.

Abstract

e13516 Background: Approximately 63,000 adults are diagnosed with non–muscle-invasive bladder cancer (NMIBC) annually in the United States. Despite strong evidence of benefit, intravesical therapy is underutilized in routine practice for NMIBC. We sought to quantify the time and financial toxicity incurred by patients traveling for intravesical chemotherapy. Methods: In a retrospective study, all the patients with NMIBC who received outpatient intravesical treatment at a high-volume infusion center affiliated with the University of Minnesota between 2021 and 2024 were included. For each visit, total travel distance, driving time, and infusion duration were recorded. Indirect costs were estimated using two cost models incorporating mileage rates ($0.70 and $1.00 per mile) and lost productivity based on local median wages (using driving time and infusion duration per visit). Descriptive statistics were generated, and interquartile ranges (IQRs) were calculated for time to start the treatments, travel distance, and estimated per-visit cost. Results: A total of 114 patients with a median age of 78 years were included. 96/114 (84.2%) patients had high-risk NMIBC and 98/114 (85.9%) received intravesical Bacillus Calmette-Guérin as the intravesical agent. Overall, 68/114 (59.6%) waited more than 6 weeks and 24/114 (21.1%) waited more than 2 months to start the treatment. The median round-trip distance to the infusion center was 25 miles (IQR, 11.2–32.2). Across a typical six-cycle induction course, patients incurred $599 (IQR, $432–$674) in cumulative indirect costs with Model 1 and $647 (IQR, $452–$759) with Model 2, excluding medical copayments or lodging. (Table 1). Conclusions: A significant subset of patients experience delays in the start of intravesical treatment. Moreover, travel and time commitments for intravesical therapy contribute meaningfully to the financial and logistical toxicity of NMIBC care. Implementing strategies such as in-home intravesical treatment delivery could potentially mitigate these barriers and improve adherence to guideline-recommended therapy. Patient access/cost outcomes (N=114). Variable Value AUA risk category, n (%) (Intermediate risk / High risk) 18 (15.8%) / 96 (84.2%) Intravesical agent, n (%) (BCG / Gemcitabine–Docetaxel) 98 (85.9%) / 16 (14.1%) Time to start treatment ≥6 weeks, n (%) 68 (59.6%) Time to start treatment ≥2 months, n (%) 24 (21.1%) Round-trip distance (miles), median (IQR) 25 (11.2–32.2) Indirect cost per visit ($) – Model 1, median (IQR) 100 (72–112) Indirect cost per visit ($) – Model 2, median (IQR) 108 (75–126) Cumulative indirect cost over six-cycle ($) – Model 1, median (IQR) 599 (432–674) Cumulative indirect cost over six-cycle ($) – Model 2, median (IQR) 647 (452–759) AUA, American Urological Association; BCG, Bacillus Calmette-Guérin; IQR, Interquartile range.