EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Alan Horwich; Steven MacLennan; EAU and ESMO Guidelines Committees

doi:10.1093/annonc/mdz296

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Alan Horwich (Corresponding Author), Steven MacLennan, EAU and ESMO Guidelines Committees

ESMO Guidelines Committee

Research output: Contribution to journal › Article › peer-review

65 Citations (Scopus)

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Abstract

Background
Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.

Objective
To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.

Design
A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.

Setting
Online Delphi survey and consensus conference.

Participants
The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.

Outcome measurements and statistical analysis
Statements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).

Results and limitations
Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.

Conclusions
These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

Original language	English
Pages (from-to)	1697–1727
Number of pages	31
Journal	Annals of Oncology
Volume	30
Issue number	11
Early online date	19 Nov 2019
DOIs	https://doi.org/10.1093/annonc/mdz296
Publication status	Published - Nov 2019

Bibliographical note

ACKNOWLEDGEMENTS
The authors would like to thank Peter E Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO.

FUNDING
All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology. There was no external funding of the event or manuscript production.

Keywords

bladder cancer
consensus
Delphi
diagnosis
treatment
follow-up
PROGNOSTIC-FACTORS
TUMOR RESPONSE
METASTATIC UROTHELIAL CARCINOMA
FOLLOW-UP
SINGLE-ARM
LONG-TERM-SURVIVAL
LYMPHOCYTE RATIO
CISPLATIN-INELIGIBLE PATIENTS
TRANSITIONAL-CELL CARCINOMA
RADICAL CYSTECTOMY

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/annonc/mdz296Licence: Unspecified

Accepted Manuscript
This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Oncology following peer review. The version of record EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees, Annals of Oncology, , mdz296, is available online at: https://academic.oup.com/annonc/article/30/11/1697/5629133
Accepted author manuscript, 773 KBLicence: Unspecified

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EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees. / Horwich, Alan (Corresponding Author); MacLennan, Steven; EAU and ESMO Guidelines Committees .
In: Annals of Oncology, Vol. 30, No. 11, 11.2019, p. 1697–1727.

Research output: Contribution to journal › Article › peer-review

Horwich, A, MacLennan, S & EAU and ESMO Guidelines Committees 2019, 'EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees', Annals of Oncology, vol. 30, no. 11, pp. 1697–1727. https://doi.org/10.1093/annonc/mdz296

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title = "EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees",

abstract = "BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome measurements and statistical analysisStatements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).Results and limitationsOverall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.ConclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.",

keywords = "bladder cancer, consensus, Delphi, diagnosis, treatment, follow-up, PROGNOSTIC-FACTORS, TUMOR RESPONSE, METASTATIC UROTHELIAL CARCINOMA, FOLLOW-UP, SINGLE-ARM, LONG-TERM-SURVIVAL, LYMPHOCYTE RATIO, CISPLATIN-INELIGIBLE PATIENTS, TRANSITIONAL-CELL CARCINOMA, RADICAL CYSTECTOMY",

author = "Alan Horwich and Steven MacLennan and {EAU and ESMO Guidelines Committees}",

note = "ACKNOWLEDGEMENTS The authors would like to thank Peter E Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. FUNDING All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology. There was no external funding of the event or manuscript production. ",

year = "2019",

month = nov,

doi = "10.1093/annonc/mdz296",

language = "English",

volume = "30",

pages = "1697–1727",

journal = "Annals of Oncology",

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T1 - EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort

T2 - under the auspices of the EAU and ESMO Guidelines Committees

AU - Horwich, Alan

AU - MacLennan, Steven

AU - EAU and ESMO Guidelines Committees

N1 - ACKNOWLEDGEMENTS The authors would like to thank Peter E Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. FUNDING All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology. There was no external funding of the event or manuscript production.

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N2 - BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome measurements and statistical analysisStatements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).Results and limitationsOverall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.ConclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

AB - BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome measurements and statistical analysisStatements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).Results and limitationsOverall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.ConclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

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KW - consensus

KW - Delphi

KW - diagnosis

KW - treatment

KW - follow-up

KW - PROGNOSTIC-FACTORS

KW - TUMOR RESPONSE

KW - METASTATIC UROTHELIAL CARCINOMA

KW - FOLLOW-UP

KW - SINGLE-ARM

KW - LONG-TERM-SURVIVAL

KW - LYMPHOCYTE RATIO

KW - CISPLATIN-INELIGIBLE PATIENTS

KW - TRANSITIONAL-CELL CARCINOMA

KW - RADICAL CYSTECTOMY

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DO - 10.1093/annonc/mdz296

M3 - Article

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SN - 0923-7534

VL - 30

SP - 1697

EP - 1727

JO - Annals of Oncology

JF - Annals of Oncology

IS - 11

ER -

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Fingerprint

Profiles

Steven MacLennan

Cite this