December 2012 #urojc transcript

#urojc transcript

Healthcare Social Media Transcript

From: Sun Dec 02 12:00:00 PST 2012
To: Tue Dec 04 12:00:00 PST 2012

 

iurojc
Let the December #urojc Please remember to use the hashtag in all tweets

iurojc
Could we ask @Joddens to remind us of the frequency of the BCG instillations for maintenance used in the study. #urojc

iurojc
#urojc Are you sufficiently convinced by the methodology & results to make changes to your BCG instillation practices?

Joddens
We used the SWOG protocol: induction 6x weekly, than 3 weekly instillations at months 3, 6, 12 (1y ) 18, 24, 30, and 36 (3y group) #urojc

iurojc
RT @captfun99#urojc what about post op chemo? Do we just offer one year of full dose bcg to all intermediate and high risk pt’s now?

daviesbj
#urojc What was the compliance rate? I have a terrible time keeping my patients on maintenance therapy.

Joddens
Methodology of study is correct, but did’t lead to answer on initial research questions! #urojc

DrHenryWoo
Agree – compliance has been hopeless in real life practice MT @daviesbj#urojc What was compliance rate? terrible time keep pts on maint Rx

daviesbj
#urojc i have trouble believing that 1/3 dosing is not tolerated > than full dosing. Anecdotally compliance is better with 1/3

Joddens
After dividing into subgroups (intermediate and high risk), practical differences in treatment length and dose could be made #urojc

Joddens
Of course a large group of patients didn’t finish their schedules. Due to side effects and to recurrence od disease. #urojc

daviesbj
#urojc would love someone to design a trial to decrease recurrence and increase compliance.

Joddens
No statistical difference with regard to side effects was reported, although we had expected to find them. #urojc

Joddens
But we didn’t investigate whether a patient that didn’t tolerate full dose did tollerate a reduced dose. #urojc

daviesbj
#urojc In the USA we can barely get urologists to give induction BCG never mind maintenance therapy. We suck.

StorkBrian
RT @DrHenryWoo: Agree – compliance has been hopeless in real life practice MT @daviesbj#urojc What was compliance rate? terrible time …

daviesbj
#urojc don’t even get me started on urologists not giving mitomycin c with TURBTs. Compliance is crap all around.

Joddens
Then I recognise 2 types of compliances: of doctors and of patients! #urojc

urodocbg
RT @daviesbj#urojc don’t even get me started on urologists not giving mitomycin c with TURBTs. Compliance is crap all around.

StorkBrian
@daviesbj #urojc Required 2 keep track of a variety of measures of limited clinical value. Induction BCG would be a good quality measure

Joddens
How about high risk patients (T1G3). BCG or immediately advise cystectomy? I prefer BCG and close monitoring of the patient. #urojc

StorkBrian
@daviesbj #urojc I don’t completely disagree but Mitomycin is > complicated. Intermittent interrupted supply & depth of resection reasons

daviesbj
Get cracking. Cheers. MT @Joddens: we didn’t investigate if a patient reduced full dose did tolerate a reduced dose #urojc

StorkBrian
@Joddens #urojc Agree. I think most patients, provided 2nd look cystoscopy w biopsies performed, would choose BCG 1st.

daviesbj
Depends. Old or Young? Did you re-resect? How big is lesion? Mostly I remove. Peace out bladder “How about high risk patients?” #urojc

Ben_L_Jackson
Upfront Rad cystectomy preferable in some: v large, multifocal, CIS, prostatic urethral disease. If>2 of these then strongly consider#urojc

Joddens
Of course it is important to do a re-TUR in T1G3 pathology within 3-4 weeks. #urojc

DrHenryWoo
RT @daviesbj#urojc don’t even get me started on urologists not giving mitomycin c with TURBTs. Compliance is crap all around.

Ben_L_Jackson
T1 tumour at reresection also is game-over for bladder preservation #urojc

Joddens
In high risk patients on BCG, eldery people seems to do worse, possibly due to selection. (younger ptns may be offered a cystectomy). #urojc

iurojc
The #urojc for December has begun. We are privileged to have primary author @Joddens with us. Asynchronous discussion over 48 hours.

Joddens
RT @iurojc: The #urojc for December has begun. We are privileged to have primary author @Joddens with us. Asynchronous discussion over 4 …

iurojc
We know from ReTweets that many are watching. Please do not feel shy to add to the discussion. Trainees especially welcome. #urojc

daviesbj
#urojc if trainees tweet I promise not to scut you out.

daviesbj
#urojc if trainees tweet they should get me a coffee as well. Feeling under caffeinated.

iurojc
#twitjc members may also be interested in joining in on #urojc – asynchronous discussion over 48 hours. See profile for explanatory notes

urodocbg
@daviesbj#urojc if trainees tweet I promise not to scut you out.” Scutting is caring.

uretericbud
@daviesbj#urojc Ben, you giving Mito after NephU yet? Have had two cases of chemical epididymitis. Anyone else? #monthstoresolve

daviesbj
@uretericbud #urojc i do give if tumor in lower ureter or bladder has CIS. Not sure why that would increase risk of epiditimitis? #ouchy

Joddens
@uretericbud How did you make the distinction between bacterial (viral) epididymitis and a chemical one? #urojc

DrHenryWoo
RT @daviesbj#urojc if trainees tweet I promise not to scut you out. @DrMarniqueB @DrVasano78 @IsaacThangasamy @oneillsar@SLa_Touche

StorkBrian
RT @iurojc: The #urojc for December has begun. We are privileged to have primary author @Joddens with us. Asynchronous discussion over 4 …

daviesbj
#urojc is there any role for 1/3 dosing of bcg after your study?? Better tolerance?? Look into that. Make me an author #paddingthecv

DrHenryWoo
RT @daviesbj#urojc if trainees tweet they should get me a coffee as well. Feeling under caffeinated. @JamesDuthie1 @sivanrij @jlpsymons

uretericbud
@uretericbud@Joddens Sterile urine /relatively normal US but severe pain. #likelyfluke #urojc

daviesbj
#urojc ok. steelers game on. Radio silence please. #SteelersNation #bleedblackandgold trainees I need beer!!!

uretericbud
@daviesbj #urojc #likelyfluke #criticaltrialinurology http://t.co/RAVEAlac #steelersweak

DrHenryWoo
@daviesbj An earlier study in 2007 showed better tolerance with 1/6 dose of BCG! http://t.co/Fhizqw7S #urojc

DrHenryWoo
MT @Ben_L_Jackson Upfront Rad cystectomy pref in some: v large, multifoc, CIS, prost urethral dis. If>2 of these then strgly consider #urojc

DrHenryWoo
#urojc RT “@uretericbud@Joddens Sterile urine /relatively normal US but severe pain. #likelyfluke

DrHenryWoo
#urojc MT“@JamesDuthie1@daviesbj @sivanrij @jlpsymons Actually just finished enjoying some of Colombia’s 2nd most popular export.

daviesbj
Typical trainee forgetting important step #urojc MT @DrHenryWoo@JamesDuthie1 @ben_l_jackson Jim, don’t forget the hashtag

JamesDuthie1
@drhenrywoo @ben_l_jackson #urojc Maybe 4 different day, what about salvage cystectomy post chemorads? 2 sick 4 surgery prior, but now…?

JamesDuthie1
@daviesbj @drhenrywoo @ben_l_jackson #urojc Just like when I left my wrist watch in that patient. Talk about overreaction.

DrVasano78
#urojc some high risk T1G3 better w early cystectomy ? @DrHenryWoo ill bring sugar free V to OT @daviesbj ill send 1, US beer 👎go steelers

DrVasano78
@JamesDuthie1 @daviesbj @drhenrywoo @ben_l_jackson holy canoli I miss Melbourne coffee… Don’t know relevance but #urojc anyway

DrSWeinstein
@iurojc #urojc Certainly will change my practice 1 yr maintenance to int and high risk groups

iurojc
@DrSWeinstein Has maintenance been standard in Western Australia? How has compliance been? Will you consider a decrease BCG dosage? #urojc

uretericbud
@uretericbud @daviesbj #urojc broken link from previous tweet: http://t.co/afkjIK1a @EUplatinum #criticaltrialinurology

iurojc
#urojc RT @drsweinstein Maintenance has not been standard inWA. Compliance poor!Decreased dose?inferior results”

iurojc
Sorry to nag. Remember to include #urojc hashtag to all tweets. Disc asynchronous & continues over 48 hours. Plenty of time to contribute.

daviesbj
#urojc which is why we should be doing a tolerability trial. Someone get a international group of urologists together. Oooh wait… #urojc

daviesbj
#urojc I nominate @DrHenryWoo to get $$ together for international BCG tolerability trial. #besttweetofday

iurojc
@peepeeDoctor Congrats. Only family takes precedence over #urojc 😀 If can, do listen in during course of discussion over next couple of days

daviesbj
#urojc BTw @NatRevUrol I already get your journal #marmite #ribena #colemans #flake

UrologyMatch
RT @iurojc: Sorry to nag. Remember to include #urojc hashtag to all tweets. Disc asynchronous & continues over 48 hours. Plenty of t …

iurojc
Couple of references on BCG dose. On the basis of current study, should we lower dose? #urojc http://t.co/yxf05yOM http://t.co/fgLAmT6d

DrMarniqueB
#urojc Any thoughts on ballpark difference in $ to treat a high risk pt full dose for 3yrs cf 1yr?! (given no LT diff in progressn/survival)

StorkBrian
#urojc @DrHenryWoo Curious if there is consensus on optimal BCG strain/product

UrologyMatch
RT @iurojc: Couple of references on BCG dose. On the basis of current study, should we lower dose? #urojc http://t.co/7V2q7spC…

daviesbj
Let this be a theme for all #urojc in the future @SportsCenter: Shaun Suisham hits 42-yd FG as time expires @steelers a 23-20 win@Ravens.

DrVasano78
#urojc @DrHenryWoo how would results differ with “high risk ” analysis if repeated with new criteria –> some old G2 now high grade UCB ?

DrAymanRashed
RT @iurojc: Couple of references on BCG dose. On the basis of current study, should we lower dose? #urojc http://t.co/pEVMR8kj.

sivanrij
#urojc bcg patients like this paper- less bcg =likely more happiness. Great to see paper directly benefiting patients

sivanrij
#urojc patients on bcg like this paper- less bcg =likely more happiness. Great to see paper directly benefiting patients

DrHenryWoo
Great idea but me just prostates RT @daviesbj#urojc I nominate @DrHenryWoo to get $$ together for international BCG tolerability trial.

StorkBrian
@DrAymanRashed Welcome to the #urojc discussion!

adoc49
RT @UrologyMatch: RT @iurojc: Couple of references on BCG dose. On the basis of current study, should we lower dose? #urojc http://t.co

DrHenryWoo
@sivanrij With recent worldwide shortages of BCG, bring 3 patients in on the same day and divide the 81mg vial into 3 – do-able? #urojc

DrHenryWoo
@StorkBrian OncoTice was strain/brand used in study. Any comments on strain – does it matter in 2012? Connaught ImmuCyst used in AU.#urojc

matthayn
RT @daviesbj: Let this be a theme for all #urojc in the future @SportsCenter: Shaun Suisham hits 42-yd FG as time expires @steelers a 23 …

UroOncMD
@DrMarniqueB #urojc there are cost savings. We do full dose induction 1/3 maintenance. Need coordination to aliquot so we have a BCG clinic

Joddens
@DrSWeinstein Please notice that from this study 1 year (full dose) IS sufficient in intermediate but NOT in high risk ptnts. #urojc

Joddens
@DrVasano78 Today high risk may be more prononced indeed. In -not published- analysis with EORTC risktables highest risk needed 3y FD#urojc

Joddens
@iurojc In first study (small n., no maintenance) low dose is inferior. In 2nd study no randomisation. Not convincing to both sides. #urojc

Joddens
@iurojc On basis of current study, lowering BCG in intermediate risk patients is probably safe – but only if continued for 3 years. #urojc

EUplatinum
RT @DrHenryWoo#urojc discussion on EORTC BCG RCT on dose/duration of maintenance treatment by @Joddens in @EUplatinum starts tomorrow …

iurojc
Good morning our European & UK friends. Please join in the current #urojc disc – Aust/NZ urologists hand the baton over to you to continue

StorkBrian
RT @iurojc: Good morning our European & UK friends. Please join in the current #urojc disc – Aust/NZ urologists hand the baton over …

StorkBrian
#Urojc As Europe/US awaken Other suggests for this @Pinterest board? Bladder Ca Support UK. http://t.co/wGA8anPh http://t.co/rsTtqlcy

BladderCancerUK
.@StorkBrian #Urojc There’s a Bladder Cancer Support Group – Australia on Facebook, very new and needs supporting 🙂

StorkBrian
@BladderCancerUK Thank you! I’ll search for it #urojc

UroOncMD
@UrologyMatch @iurojc #urojc I’m more interested in shortening treatment period. Access to BCG “slots” in our clinic can be limited at times

StorkBrian
RT @UroOncMD@UrologyMatch @iurojc #urojc I’m more interested in shortening treatment period. Access to BCG “slots” in our clinic can be limited at times

StorkBrian
@_TheUrologist_ #urojc Day #2 begins Discussion – BCG & maintenance BCG for TX of bladder cancer

iurojc
@StorkBrian @_theurologist_ Still another 8 hours before we hit day 2 – lol #urojc

UrologyMatch
@StorkBrian@_TheUrologist_ #urojc Day #2 begins Discussion – BCG & maintenance BCG for TX of bladder cancer”

StorkBrian
Apologies Still in Day#1 of #urojc Clearly confused by multiple time zones, time change, and lack of sunlight

dmsomford
@iurojc for better personalized care we need to differentiate BCG-responders from non-responders before BCG and treat accordingly#UROJC

Joddens
@dmsomford @iurojc #urojc As in guidelines EAU: “minumum of 1 year maintenance” Practical: yes. Sufficient for High Risk: no.

Joddens
Good to see Dutch participants in this JC as well, Rick! @dmsomford #urojc

dmsomford
@Joddens @iurojc #urojc for (extreme) high-risk cystectomy is also a consideration while 3 years of BCG leaves substantial progression risk

dmsomford
@Joddens #urojc sure, a well-written paper deserves a good discussion!

Joddens
@UroOncMD As in many countries delivery of care to patients is dependent upon availablitily. But it’s not in patients interest! #urojc

StorkBrian
@lawrentschuk #urojc MT @iurojc SWOG BCG protocol will suffer. 1yr. maintenance easy,sensible, cheaper-Game-changing paper.

daviesbj
#urojc paper as game changer for SWOG protocol? Nobody does the SWOG regimen. Can not change a game that has not begun.#daviesdeepthought

Joddens
@daviesbj Altough not a game changer, it advocates maintenance over only 6 instillations. Helpful? #Urojc

lawrentschuk
#urojc SWOG BCG protocol will suffer.1yr maintenance easy,sensible, cheaper-Gamechanging paper. Pity not dose reduce.Need more 4#bladderca

daviesbj
#urojc Dit is een grote studie. Ik wou dat we een manier om te helpen met de BCG bijwerkingen. @joddens

Joddens
@daviesbj International JC now turned into a multilinguistic JC! Thanks to Dutch experience or Google translate?:) #urojc

Joddens
@daviesbj #urojc Indeed, side effects remain problem in treatment compliance. Some benefits of oflox. are described. JUrol. 2006;176(3):935

daviesbj
@joddens Google translate. Good example of people who can not read english or dutch being able to follow the conversation #urojc

dmsomford
@daviesbj @Joddens Very considerable of you to translate for the two Dutchies participating so far in this #urojc, more to follow?

audvin
Around the World in 48 Hrs: International Urology Journal Club Twitter http://t.co/aC1EJASt via @storkbrian #UROJC

uretericbud
@daviesbj Disagree. Live by SWOG — many on it (all HGT1’s, miltifocal HGTa/CIS) Tolerability not huge issue. #nancynaysayer #urojc

sivanrij
#Urojc where to for cis? Obviously Excluded in this trial. Can we apply any results across? A Similar trial for cis?

daviesbj
@uretericbud the good people of Philli must have a phenotype not expressed by the hardy patients of western pa #eaglessuck #urojc

_TheUrologist_
Note duration of Tx: SWOG only 16% in maintenance arm completed 3yr, here 34-35% of 3yr groups got there #urojc

_TheUrologist_
Also, no differences in amount of Tx received between 1/3dose and full #urojc

UroOncMD
@daviesbj @uretericbud #eaglessuck #urojc Easy therem steele curtain more like aluminum this year

_TheUrologist_
Remember talk but can’t find ref #urojc MT @njtouma: BCG strain matters in high risk #bladdercancer immucyst is best says Kassouf#CUA2012

_TheUrologist_
SWOG used Connaught (immucyst derived from this), @EORTC used Tice (we use this here at birthplace of BCG FOR #bladdercancer)#urojc

_TheUrologist_
@uretericbud @daviesbj haven’t had any grief with full dose coming on 3yr either #urojc

daviesbj
@UroOncMD @uretericbud #urojc compared to the eagles it’s an Iron curtain

UroOncMD
@Joddens #urojc fair point, but if I can get more patients treated without delay with “equally” effective care, its a winner.

uretericbud
@daviesbj @UroOncMD #urojc Meanwhile, does everyone use 6 months to define BCG-refractory dz? http://t.co/XrSACv6f #FalconsFan

daviesbj
Let’s make this grow. How about it #urojc @Slate: Decembeaver: It’s like Movember, only for women, and for pubic hair:http://t.co/NBmMyXay

Tdave
Looking for consensus amongst you oncology jocks on this #idostones #urojc

daviesbj
@uretericbud we use either early failure (<3months) or failure after two induction cycles. Konety trained. #falconsareoverrated #urojc

Joddens
Eau guidelines: failure is second recurrence despite BCG continuation. But with the risk of meanwhile progression.. #Urojc

Joddens
A second induction course of BCG is used a lot but evidence of superiority above continuation normal cycles is lacking. #Urojc

Joddens
How about alternative treatments: Device assisted MMC with Synergo or EMDA? Seems to be experimental for decades. Any experience?#Urojc

dmsomford
@uretericbud We use 6-mo and two induction cx to define BCG-refractory dz, but agree with @Joddens that repeat induction = debatable.#urojc

JimCatto
#urojc @uretericbud @daviesbj i get the benefits of bcg, but how to safely survey the bladder? http://t.co/2b08nr36

iurojc
For the many of you watching #urojc please feel to join in the discussion. Great opportunity to ask that burning question!

iurojc
Best tweet prize for Dec #urojc kindly donated by @NatRevUrol – offering 1 year on-line subscription. Trainees esp welcome to join in!

StorkBrian
RT @iurojc: Best tweet prize for Dec #urojc kindly donated by @NatRevUrol – offering 1 year on-line subscription. Trainees esp welcome t …

Joddens
@JimCatto Patient selection for invasive therapies is key. Early sign of real failure/ resistence to BCG are lacking. #urojc

dmsomford
@Joddens @JimCatto #urojc predicting BCG-resistance should be focus of future research as it determines candidates for upfront cystectomy.

uretericbud
RT @JimCatto#urojc @uretericbud @daviesbj i get the benefits of bcg, but how to safely survey the bladder? http://t.co/2b08nr36

UrologyMatch
@JimCatto#urojc @uretericbud @daviesbj i get the benefits of bcg, but how to safely survey the bladder? http://t.co/11dJFuP4”

DrVasano78
RT @iurojc: Best tweet prize for Dec #urojc kindly donated by @NatRevUrol – offering 1 year on-line subscription. Trainees esp welcome t …

IsaacThangasamy
@iurojc Following Dec #urojc from Phuket. Trying to grasp difficulties of maintaining adequate therapy and surveillance. #learningontherun

IsaacThangasamy
RT @DrHenryWoo: RT @daviesbj#urojc if trainees tweet I promise not to scut you out. @DrMarniqueB @DrVasano78 @IsaacThangasamy@oneill …

IsaacThangasamy
#urojc RT “@uretericbud@JimCatto @daviesbj @urooncmd “When opinions abound, truth is hard to find.” #bladdercancer#therapeuticwildwest

uretericbud
@JimCatto @daviesbj @urooncmd: “When opinions abound, truth is hard to find.” #bladdercancer #therapeuticwildwest #urojc

JimCatto
@uretericbud @daviesbj @urooncmd #urojc agreed. Multiple treatments=none work particularly well

JimCatto
RT @iurojc: Best tweet prize for Dec #urojc kindly donated by @NatRevUrol – offering 1 year on-line subscription. Trainees esp welcome t …

JimCatto
Better not be @daviesbj again ..#fix…. @iurojc: “Best tweet prize for Dec #urojc kindly donated by @NatRevUrol

 

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