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Light microscopy of the internal lining of the urinary bladder; haematoxylin and eosin stain
Managing High-Risk NMIBC

Expert and patient insights

Last updated: 10th Oct 2025
Published: 10th Oct 2025

Joshua Meeks explores how NMIBC trial design can evolve to better reflect patient realities, from inclusive recruitment and pragmatic eligibility criteria to the integration of real-world data and quality-of-life outcomes. Are we measuring what truly matters to patients? What motivates someone to enroll in a trial? And how can we better understand the barriers that prevent participation in the first place? Drawing on insights like “Progression is the most scary endpoint to many, but recurrence is the one that they deal with the most,” Meeks highlights the importance of involving patient advocates and multidisciplinary voices to ensure trials are not only scientifically rigorous, but also meaningful and accessible. View transcript.

Chapters
00:04 Designing inclusive NMIBC trials 
03:46 Can NMIBC trials be more inclusive?
06:28 Are we measuring what matters?
09:09 Oncology insights for NMIBC trials
12:46 QoL tools in NMIBC research
14:23 Patient voices in NMIBC research
15:40 Making NMIBC trials accessible
16:52 Real-world data in NMIBC trials
18:24 Barriers to better NMIBC trials
20:22 Choosing the right NMIBC therapy
21:20 De-escalating NMIBC therapy


Meet the expert

Joshua Meeks, circular photoJoshua Meeks, MD, PhD

Joshua Meeks is an Associate Professor of Urology, Biochemistry, and Molecular Genetics at Northwestern University Feinberg School of Medicine and Section Chief of Robotic Surgery at the Jesse Brown VA Medical Center in Chicago, Illinois, USA. He is a urologic surgeon with expertise in the diagnosis, treatment, and management of bladder cancer.

Disclosures: Consultant for AstraZeneca, Bristol Myers Squibb, Calibr, CG Oncology, Ferring, ImmunityBio, Imvax, Janssen, Merck, Pfizer, Photocure, Prokarium, Protara, Seagen/Astellas, and UroGen.

How do cultural beliefs and healthcare systems shape patient expectations in NMIBC care? Félix Guerrero-Ramos shares practical strategies for bridging communication gaps, such as adapting explanations to each patient’s background and leveraging family and social support. He explores how emotional responses, health literacy, and systemic access all influence care for people with NMIBC. “We had a patient who missed multiple appointments simply because he couldn’t understand the letter [he received],” Guerrero-Ramos recalls, as he underscores the importance of listening to the patient first and tailoring care to diverse needs, especially when the path to treatment is complex. View transcript. Meet the expert.

Chapters
00:00 How culture guides patient decisions
02:12 Bridging cultural differences
03:33 Cultural views on risk in NMIBC
04:52 Regional systems and NMIBC access
07:14 Policy and access in NMIBC treatment
09:28 Navigating available NMIBC treatments
10:16 Culturally-tailored communication
11:55 Caregiver roles in NMIBC decisions
13:44 Reaching underserved populations
16:04 NMIBC: Tackling stigma and access gaps
16:42 Personalizing NMIBC care across cultures

Patient and caregiver voices in bladder cancer

What do real-world voices reveal about the bladder cancer journey? This infographic draws on interviews with nine patients and three caregivers across the USA, Germany, and Italy, highlighting missed diagnoses, emotional distress, treatment side effects, and challenges faced by caregivers. It offers a visual snapshot of how communication, empathy, and support shape care, and how these experiences vary across regions. 

NMIBC infographic

Infographic download

Meet the expert

Dr. Félix Guerrero-Ramos, circle photo, profile pictureFélix Guerrero-Ramos, MD, PhD, FEBU

Félix Guerrero-Ramos is an attending urologist at Hospital Universitario 12 de Octubre in Madrid, Spain, where he coordinates the Urological Oncology section. He specializes in surgeries within urological oncology and has been the principal investigator for over 30 phase 1–4 clinical trials on bladder and renal cancer. He also collaborates as a Professor and Academic Tutor for final-year medical students at the Faculty of Medicine, Universidad Complutense de Madrid.

Disclosures: Research support / Principal Investigator for Astellas, AstraZeneca, Bristol Myers Squibb, Cepheid, Combat Medical, enGene, Fidia, Johnson & Johnson, MSD, Pfizer, Roche, Seagen, Taris, and UroGen. An employee of SERMAS (Servicio Madrileño de Salud). Consultant services for AstraZeneca, Bristol Myers Squibb, Combat Medical, enGene, Johnson & Johnson, Merck, MSD, Nanobots Therapeutics, Pfizer, Roche, and Taris. Stockholder in CG Oncology, Johnson & Johnson, and Pfizer. Speaker bureau for AstraZeneca, Bristol Myers Squibb, Combat Medical, Janssen, Johnson & Johnson, Merck, MSD, Nucleix, Pfizer, Palex, and Recordati. Travel support for Alter, AstraZeneca, Combat Medical, Fidia, Ipsen, Johnson & Johnson, Nucleix, Pfizer, Recordati, and Salvat. Member of scientific advisory boards for AstraZeneca, Bristol Myers Squibb, Combat Medical, enGene, Johnson & Johnson, MSD, Nucleix, Pfizer, Roche, and Taris. Manuscript support from AstraZeneca, Bristol Myers Squibb, Combat Medical, Janssen, Johnson & Johnson, and Pfizer.

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