As noted by Lopez-Beltran and colleagues, bladder cancer management has undergone substantial transformation over the past decade, driven by advances in molecular diagnostics, risk stratification, and the rapid expansion of immunotherapy, targeted therapies, and antibody-drug conjugates. These advances have important implications for oncology nurses, who play a central role in coordinating care, educating patients, monitoring treatment-related toxicities, and promoting adherence throughout the continuum of care.
Although transurethral resection followed by risk-adapted intravesical therapy remains the cornerstone of treatment for non-muscle-invasive bladder cancer, new options—including intravesical gene therapy, combination chemotherapy, and immune checkpoint inhibitors—are expanding treatment opportunities for patients with Bacillus Calmette-Guérin-unresponsive disease.
For muscle-invasive bladder cancer, cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy continues to represent the standard of care for eligible patients, although bladder-preserving trimodality approaches have emerged as effective alternatives for carefully selected individuals. In advanced and metastatic disease, the introduction of immune checkpoint inhibitors, fibroblast growth factor receptor (FGFR)-targeted therapies, and antibody-drug conjugates has significantly improved survival while reshaping treatment sequencing and long-term disease management. Molecular profiling and emerging biomarkers such as circulating tumor DNA offer promise for increasingly personalized treatment strategies, although their routine clinical implementation continues to evolve.
As treatment regimens become increasingly complex, nurses must recognize the unique adverse-event profiles associated with newer therapies, including immune-related toxicities from checkpoint inhibitors, dermatologic and metabolic complications associated with antibody-drug conjugates, and ocular, electrolyte, and dermatologic toxicities related to FGFR inhibitors. Early recognition, prompt assessment, and multidisciplinary management of these adverse effects are essential to minimize treatment interruptions and optimize outcomes. Nurses are also instrumental in supporting patients receiving intravesical therapies through education on treatment expectations, symptom management, infection prevention, and surveillance requirements.
Beyond physical care, patients with bladder cancer frequently experience anxiety, altered body image, urinary dysfunction, and reduced quality of life related to repeated procedures, urinary diversion, or long-term systemic therapy. Oncology nurses are uniquely positioned to address these psychosocial concerns through ongoing education, symptom assessment, supportive care interventions, and coordination with rehabilitation and survivorship resources.
As bladder cancer care continues to evolve toward precision medicine, oncology nurses must remain informed about emerging therapeutic options and biomarker-driven treatment strategies to effectively educate patients, anticipate complications, and facilitate evidence-based, patient-centered care across all stages of disease.
Reference
Lopez-Beltran A, Cookson MS, Guerico BJ, Cheng L. Advances in diagnosis and treatment of bladder cancer. BMJ. 2024;384:e076743. doi:10.1136/bmj-2023-076743
AI disclosure: Generative artificial intelligence (AI) was used to prepare this article. American Nurse Journal editors critically reviewed and revised the AI-generated content, verified all factual information and references, and assumes full responsibility for the accuracy, originality, and final version of the manuscript.
