Sam Chang: Hi, my name is Sam Chang. I'm a urologist at Vanderbilt, and we are quite fortunate to have a future superstar in urologic oncology, Dr. Bryn Launer. Dr. Launer is a chief resident at Vanderbilt and will be doing urologic oncology at Mayo Clinic in Rochester. She's been spearheading some work specifically on utilizing a new position that we've helped establish, which looks at actually helping our female bladder cancer patients with a clinical care coordinator. She and Bree Duncan have actually put their work together that's been presented at Southeastern section as well as the AUA.

I'll turn things over to Dr. Launer.

Bryn Launer: Thanks, Dr. Chang. Great. Well, thank you guys so much for the opportunity to talk about this exciting work that we're doing here at Vanderbilt with development of a new role. This is a female bladder cancer clinical care coordinator that we've developed here at Vanderbilt. We're really excited to share.

Let me get right into it. We know that the vast majority of patients diagnosed with bladder cancer are male, but female patients diagnosed with bladder cancer are actually more likely to present with muscle-invasive bladder cancer on diagnosis. They have higher cancer-specific mortality. Some literature suggests that they have decreased surgical outcomes, and we know that the time from presentation with symptoms of hematuria or irritative LUTS to the diagnosis of bladder cancer is actually longer in female patients than male patients. In addition, most patient-centered resources and research studies regarding bladder cancer are actually targeted towards men.

And so here at Vanderbilt, we aimed to introduce a novel role for cancer patient navigation and a dedicated female bladder cancer clinical care coordinator role. We have actually called this FBC4 here at Vanderbilt.

Who did we choose for this role? We found a trained clinical research nurse specialist who was already here at Vanderbilt, already integrated in our systems, and working with the urology clinic who previously was working fully in clinical trials within our clinic. But through a very thankful and kind patient, we had funding to pursue this new role for her, which is a combination of her skills, where she's finding female bladder cancer patients and both reviewing available clinical trials with them, assisting with enrollment. But also majorly, majorly accompanying them on every step of their journey through their bladder cancer care here at Vanderbilt.

Preoperatively, this coordinator accompanies our patients to their first urology visit with their surgeon after a new diagnosis of bladder cancer and then also sits down with the patient afterwards. She takes notes for them. She reviews and summarizes, really makes sure that they understood what was going on in the visit, answers questions because, again, she's experienced. She's ingrained in this role already.

They come with a patient to their preoperative appointments, with their surgeon, with their wound care for ostomy marking, even their preoperative anesthesia appointments. They're there right by their side. They're available during business hours. We have actually a work phone that they can call, text, and email on. And then this coordinator is also very kindly available for urgent needs after hours or on the weekends after the surgery.

Again, all these patients here at Vanderbilt that we've enrolled so far actually have muscle-invasive bladder cancer and underwent radical cystectomy with conduit formation or neobladder for a couple patients.

Postoperatively, our coordinator reviews postoperative appointments often adjusting timing per protocols. Us as residents, we try really hard to get that scheduling right, but when it's not right, she catches it and we're very thankful for that. This nurse can perform stent and staple removal herself. She reviews medications, postoperative medications on discharge to make sure all is compliant. She even looks at labs and imaging with the patients. If a patient has a CT scan back and they're anxious, they want to talk about it, they can call her. She talks with them about it. Of course, she always checks in with the surgeons if there's something very concerning.

Our coordinator follows with our patients through six months postoperatively and then as needed after. Some patients are riding off into the sunset. They're doing great. But some patients need a little extra help and she's always available for those patients to reach out to, which is really wonderful.

This initiative started in 2022. Since then, we've enrolled 43 female patients, all of whom had cystectomy and some type of diversion formation here at Vanderbilt for muscle-invasive bladder cancer. Their mean age was 64, the majority of these patients were white, and about 23% underwent pelvic organ sparing RC/IC.

Brief results here. When we surveyed these patients, 74% reported a strong preference for our institution, specifically because we offered this bladder cancer care role. About half of the patients offered to become peer support members, so offered to be available for future female bladder cancer patients going through the same journey that they did. We avoided 10 unnecessary emergency department visits because we had this cancer care coordinator available, which is really incredible when you think about the strain on the healthcare system. 10 visits is a big deal for 43 patients, and we even cancelled 27 unnecessary visits. All of this is really fantastic.

Future directions. Where are we taking this next? We're excited with these initial results showing patient satisfaction and engaging with their care team. We really feel that this female bladder cancer clinical care coordinator role staffed by a trained nurse who's integrated into our system gives a higher level of patient care than just patient navigation. She's not just calling to help them figure out appointments and navigate the system. She's helping them medically. She's helping them emotionally and socially, and she's doing more than just pulling stents and staples. She's helping them interpret their results. It's really incredible.

Our next steps are to expand to non-muscle-invasive bladder cancer and trimodal therapy. There's some interest from our hematology oncology department, and we're excited to partner with them. In the future, we hope to do a deeper dive into these outcomes. We are building a database with Clavien-Dindo complications and things like that. I'd be really interested to see truly how are these patients doing compared to the generation that came in before them without this role. How have we improved them even more tangibly than just their satisfaction and saving them from the emergency department?

We're really excited to publish this work soon, and we're even more excited to keep diving in deeper. Thank you.

Sam Chang: Bryn, fantastic presentation and more importantly, fantastic work. Obviously, we would love to have this capability for all of our patients. It's difficult with limited manpower to be able to offer all of these, but for significant cancer interventions, you can see the real benefit when it comes to someone in this type of position offering this type of support.

As you look forward, how do you think we can operationalize it more? What should we focus on in terms of helping other programs setting up this type of system?

Bryn Launer: That's a really great question, Dr. Chang, and I do think that this role right now is pretty darn unique to Vanderbilt. I think that it's something that we've already had some interest from other institutions in replicating.

I think providing a clear framework for how we do our preoperative setup, what types of visits these patients are having, and the degree of involvement by this clinical care coordinator is very valuable to other institutions. Just the system of availability, having a work phone, being available for calls, and reaching out and things, but also that initial investment in the dedicated funds for this role I think are really valuable.

Just coming up with a protocol, coming up with a template for saying, hey, this role is out here, it's valuable. Showing potentially some financial benefit I think would be really important as well so that other institutions can take what we've done and run with it.

Sam Chang: Bryn, very much looking forward to the manuscript. I know it's been submitted, and I think the next steps, just as you say, is further expansion and hopefully integration. I would love to bring it throughout our cancer center. I'd love to make it something that we can offer to other patients with other cancers, and I really applaud you for your efforts.

Most importantly as well, wish you good luck in your chief resident year as well as your move on to Mayo. They're very, very fortunate to have you.

Bryn Launer: Thanks, Dr. Chang. I really appreciate it.