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Transcript of What You Need to Know About COVID Vaccines and Bladder Cancer with Dr. Seth Lerner and Dr. Laila Woc-Colburn

You can listen to the podcast here.

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit B-C-A-N, dot, O-R-G.

Rick Bangs:

Hi. My name is Rick Bangs, and I’m the host of Bladder Cancer Matters, a podcast for, by, and about the bladder cancer community. I’m also a survivor of muscle-invasive bladder cancer, the proud owner of a 2006 model year neobladder, and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN, producers of this podcast. Today’s episode is brought to you by our partners, FerGene and Merck. FerGene is a gene therapy company dedicated to creating and delivering innovative solutions to urologists, and those affected by non-muscle invasive bladder cancer. And for 130 years, Merck has been inventing for life, bringing forward medicines and vaccines for many of the world’s most challenging diseases, in pursuit of their mission to save and improve lives. We are grateful for their support. I am pleased to welcome today’s speakers, Drs. Seth Lerner and Laila Woc-Colburn.

Dr. Seth Lerner is a professor of urology, and holds the Beth and Dave Swalm Chair in urologic oncology in the Scott Department of Urology, Baylor College of Medicine. He is also director of urologic oncology and the multidisciplinary bladder cancer program, and faculty group practice medical director for the urology clinic. Dr. Laila Woc-Colburn is an attending physician on the infectious diseases consultation service at Emory University Hospital, and Emory University Midtown Hospital. She provides outpatient service at the Emory Healthcare Infectious Diseases Clinic. In today’s episode, we are going to talk about the challenges of managing bladder cancer during a global pandemic, and concerns about timing bladder cancer treatments with the COVID vaccine. The bladder cancer community, which generally tends to be older adults, faces above average risk of serious and potentially deadly consequences if they contract COVID. With new vaccine options currently approved, and more on the way, what do bladder cancer patients need to know? Okay, let’s jump right into the questions. Dr. Woc-Colburn, let’s start with some basics on the COVID vaccines. Does vaccination reduce or completely eliminate my risk of contracting the virus?

Dr. Woc-Colburn:

So, thank you for having me over on the show. Vaccines are going to help you reduce COVID. The vaccines are designed for us not to shed as much, and designed for us to not get as sick as much. So, it does both.

Rick Bangs:

Now, how are the COVID vaccines different from one another? Can you explain?

Dr. Woc-Colburn:

Yeah. We have different platforms. One of the things people think right now is that we have created a new platform for vaccines, even though we’d been working on them for the last 20 years. So, the platform that is most often quoted is the messenger RNA, and those are for the biotech Pfizer and Moderna vaccines. And how does this work is, the messenger RNA, you can think about it just as a message, receives the message, and then it kind of shifts towards your immune system, and tells the immune system, “Hey, I have to spike protein. I want you to learn about the spike protein, because this is bad. I want you to make antibodies, so when you see this, you can attack it.” And so, it’s like a little messenger. The body remembers this, and when it actually sees it coming, and sees this virus with the little spike protein, the body’s like, “Aha. I’ve seen this before, and I’m going to make the right soldiers to attack this so I don’t get sick.” So, that’s the messenger RNA, and that’s the basis for the Pfizer and the Moderna.

Other platforms that we have out there is a vector, or a viral vector. Instead of having a messenger, you have a vector. So the vector, in this case, is called adenovirus. Adenovirus is a virus that can cause conjunctivitis, and kind of some GI symptoms, and things like that. It packs the little spike protein, and then it goes and fools the immune system saying, “Hey, I’m an adenovirus. You’ve seen me before, but I have a special present for you.” Opens up the present, and then the body’s like, “Oh, okay, I get it. I have to make now antibodies against this.” And so when it sees the spike protein delivered by the little vector, it’s able to now mount that response. And when it sees in real life, does the same thing. And this ones are the ones that we know as the AstraZeneca, or the ChAdOx. It’s also the ones called Sputnik, and the other one is the one from Johnson & Johnson.

Rick Bangs:

Now is one type of vaccine better, and why or why not? And let’s include some of the yet to be approved vaccines that you mentioned in your answer.

Dr. Woc-Colburn:

So, the Pfizer and Moderna are about 94 and 95% as active, or efficacious. The one from ChAdOx is about 77, 80%, and Johnson is about 66 to 80%. We need about 65 and 70% of it to work to get to that immunity. If you want to think about it, it’s like the flu vaccine, the flu vaccine has about 70 to 80%, and it protects us every year.

Rick Bangs:

Dr. Lerner, let’s apply vaccination to the bladder cancer context. How can I minimize the risk of COVID, or COVID vaccination, interfering with my bladder cancer treatment, or vice versa? Would your answer vary by treatment, and do you have any advice on how I should time my vaccine with my treatment schedule?

Dr. Seth Lerner:

Sure. And thank you for inviting me to the podcast. So in terms of the risk of COVID, obviously cancer patients are at higher risk, particularly if they’re undergoing a type of treatment that would suppress their immune system. So, that would be more in the range of chemotherapy, for example, if they had spread of the cancer and not so much intravesical therapy for non-metastatic disease. And so, whenever they’re out and about for whatever reason, or visiting the hospital, or visiting the clinic, social distancing, wearing a mask, etc. And of course, if they have any symptoms or fever, they should really stay home and quarantine. Get tested, and then sort of reevaluate once that passes. In terms of the vaccination, there’s really no evidence to suggest that that will interfere with their bladder cancer treatment. Certainly not in the case of if they’re getting BCG, or chemotherapy installations in the bladder.

Now, the patients who are getting BCG know full well that it can produce a range of symptoms, including flu-like symptoms. So some people will have fever, some people will even have joint pain or muscle aches, and usually those will subside within 24 to 48 hours. So those could potentially be, and I’ll defer to Laila, short-lived symptoms that could occur after vaccination as well. So it would be better to not time the vaccination in very close proximity to getting their intravesical therapy. So I would say, maybe no less than 48 hours before a treatment, and then let their symptoms resolve post-treatment, to either get their first shot or their second shot.

Rick Bangs:

Okay. So Dr. Woc-Colburn, will I be offered a vaccination by the institution where I’m being treated? Before my surgery, my chemo, my radiation, or my immunotherapy?

Dr. Woc-Colburn:

It all depends on the institution, as well as the state governance, and the amount of supply that is there. So, let’s break it down. Let’s for example, say you have surgery. Ideally, you would like to have your vaccine, at least completed the whole two doses, and that will take you about three to four weeks before your surgery. Or you can have that two weeks after surgery. And we say that is because of potential side effects. Some people will have a little bit of a fever, body aches, and you don’t want to make sure that that’s not the surgery that happened.

The other question was that, if you have your chemotherapy, ideally would be before you get your chemotherapy. We know that certain chemotherapies can blunt the immune response reaction, so you want to be up to it, your best immune system, before you get the chemotherapy. But if you at least have an immunosuppressive therapy, what the National Cancer Society has said, is that you want to wait at least three months after you’ve completed this immunosuppressive therapy, because then your immune system actually is 100% charged to remember the vaccine. And so it’s a matter of timing, and a matter of knowing what vaccines your institution is going to have.

Rick Bangs:

Okay. So Dr. Lerner, assuming that I’m offered, or perhaps even sign up on my own, for a vaccine before my treatment, what are the implications on scheduling my bladder cancer treatment?

Dr. Seth Lerner:

Yeah. Thanks, Rick. So I think the most important thing is that throughout the pandemic, from the beginning, cancer surgery was always prioritized because of the obvious importance of the potential for delay in surgery, or for that matter, treatment affecting the outcome. And there’s actually some data to show that delays in surgery, and delays in treatment, have had a negative impact on ultimate outcomes. So the most important thing is trying to get the surgery that your surgeon has recommended, done in a timely fashion. So, what I’m trying to get people to do, of course, is get vaccinated in advance of their surgery. A hospital’s a very safe place, but obviously there’s risks of getting COVID both out in the community, that you can bring in to the hospital. And there’s data to show that patients who undergo, for instance, major surgery, and are subsequently found to be COVID positive, have a much worse outcome, and particularly pulmonary complications. And Dr. Woc-Colburn can certainly comment on that.

So if… Let’s take the patient who’s having a transurethral resection of a bladder tumor. So, the patients are most familiar with that, for those who are not that are on the call, this is done under a general anesthetic. We put a little scope into the bladder, we can see everything, and we can remove a tumor, or certainly get samples. And that’s typically done as an outpatient, so that’s a little easier to schedule both the first and the second dose around that. Just making sure that the patient’s fully recovered, usually only a few days, after that operation. It gets a little trickier in terms of timing in patients who are undergoing a major operation, say a radical cystectomy, or even a partial cystectomy, which we do on occasion. And there’s a period of time post-operatively where we would not really want a patient to get vaccinated, because of just sort of changes in the immune system with respect to surgery, and sort of risk of post-operative complications. So we’d want that patient fully recovered.

So if I can get a patient vaccinated say, within a week of a radical cystectomy, and if they’re getting the Pfizer vaccine, their second dose would be two weeks post-op. Moderna would be four weeks… Sorry, three weeks post-op. I’m comfortable with that. And I think, and Laila may want to comment on this because I just saw some data to suggest that there’s… We don’t recommend delaying the second dose of the vaccine, but it could be delayed another week or two if the patient needed a little bit more time to recover from their cystectomy. I don’t know. Laila, do you want to comment on sort of that timeframe for that second dose, with either of the two currently approved vaccines?

Dr. Woc-Colburn:

Yeah. Thanks, Seth. That is a great question, and it’s actually something that the scientific community has been looking. One is, in order to be able to maximize the number of people that we vaccinate, at least with one dose, so that has come up. We can actually delay the vaccine after your first dose, up to six weeks. So if you have the Pfizer, you have between 21 to 42 days to get it. And if you have the Moderna, you have between 48… Between 28 days and 48 days, so after six weeks. The first vaccine gives you enough immunity, and we’ve seen that, that your antibodies actually go, and your antibodies is what we want. Those are the little soldiers and memory cells that are going to help you fight very quickly, especially after the first 7 to 10 days after receiving the first shot.

Dr. Seth Lerner:

Yeah. I mean, just this and the other thing. I think we were talking before about just ordering the vaccine. So, certainly I can speak to Texas guidelines. So essentially, Laila, correct me if I’m wrong, any patient, any adult patient with a diagnosis of cancer, qualifies regardless of age. And so we can order a vaccine, and that doesn’t necessarily mean that you go to the top of the list, but at least you can get on a list to get vaccinated if you haven’t sort of tried that before. So, we would just urge everybody to reach out to their urologist, or their medical oncologist, or radiation oncologist, if they haven’t already, to request an order for a vaccine.

Dr. Woc-Colburn:

Yes, that’s correct. So, we divide the part of administering according to tiers one through three. And the tier that we’re right now vaccinating is the one to 1B and 2, meaning that if your age over 65, you get to that. If you’re a healthcare worker, obviously, that’s kind of a no-brainer, but if you have a chronic condition, so cancer goes into that part of the tier 1B and tier 2, and that is national-wise put through. So, it’s a matter of fact of asking your provider. Also, I know that some clinics have sent reminders to their patients that vaccines is available, and to sign up.

Rick Bangs:

Let’s pause for a moment, for a word from the Bladder Cancer Advocacy Network.

Voice over:

The Bladder Cancer Advocacy Network, BCAN, invites you to join us for our 10th annual virtual walk to end bladder cancer. Saturday May 1st, 2021 at 11:00 AM Eastern Time. Our virtual walk is an interactive, nationwide alternative to in-person walk events that involve thousands of participants walking from the place of their choosing. The overarching walk theme is, no one walks alone. As we make people aware that they are not walking alone during their difficult bladder cancer journey, an important reminder during this time of social distancing. Critical funds raised through the virtual walk help BCAN increase awareness about one of the most commonly diagnosed cancers in the US, support hundreds of thousands of people living with this disease, and raise funds for much needed bladder cancer research. The virtual walk will be broadcast on BCAN’s social media channels, and will include compelling videos from bladder cancer patients, caregivers, doctors, and more. Learn more about the May 1st virtual walk to end bladder cancer at BCANwalk.org. That’s B-C-A-N, walk, dot, O-R-G. Or contact us at (301) 215-9099.

Rick Bangs:

We’re back with Drs. Lerner and Woc-Colburn, talking about the COVID vaccine and its implications on bladder cancer. Okay. So this next question is for both of you, and let’s start with Dr. Woc-Colburn. Are any side effects from the vaccine similar to bladder cancer treatment side effects? And what should I watch out for, or even report to my medical team?

Dr. Woc-Colburn:

Let’s start with the local side effects, is that you can… Where you get it, the vaccine, which is usually your shoulder, either right or left, depending which is your dominant hand. You can have a little bit of painful area, kind of similar to when you get a flu shot. You get the jab on, it can get a little red, a little bit painful, and then that’s all some people experience. Other patients have experienced that after the first initial 12 to 24 hours, you might feel a little more fatigue. Some of them mount a temperature, you feel kind of run down, but that’s not everybody. And some might have experienced some kind of GI symptoms, like mild diarrhea, which only lasts for about a day, and then you’re good to go.

Dr. Seth Lerner:

Yeah. So, Laila, maybe take that a little step further. I think there’s some confusion out there sometimes that, if I get vaccinated am I going to get COVID? Or am I going to have prolonged symptoms? And of course, the answer to the first question is definitively no, but the second question is just as simply as you described it. The reaction to the vaccine, from what I understand, can be dramatic in some patients, but it’s also very short-lived. And resolves generally, what? Within 24 to 36 hours?

Dr. Woc-Colburn:

Yeah. So, one way to look at it is that, initially the fever and the muscle aches are some of the general side effects that can mirror COVID-19 symptoms. But I mean, that is just telling you that the body’s getting used to and recognizing this new spike protein, in order to mount that defense. Often we see this more with a second dose, because you already being challenged the first time. Most of the time, the side effects are mild, and usually fade within 24 hours. And you shouldn’t feel prolonged effects from the vaccine afterwards, and you’re not getting COVID out of it. So you’re not going to get COVID from the vaccine, where you just getting it’s a little piece of that sequence of protein spike, so your body knows what’s going on for your immune system.

Dr. Seth Lerner:

So Rick, in terms of the other part of the question, we were talking a bit before about BCG. So, BCG can produce very similar side effects that we often sort of call, flu-like symptoms. Again, what I was talking about before, some people will get low-grade fever that can last a day or two, muscle aches, rarely dramatic, where it really kind of knocks you off your feet like the flu does. And of course, as you’ve just heard, those symptoms can overlap with side effects of the COVID vaccination, but both of which generally resolve within a day or two. As far as what I should report to my medical team, obviously we’d like to know if you’re vaccinated or not, or… And of course, if you have questions about the timing of the vaccination, please reach out to your treating doctor.

I think it becomes critically important when you’re getting, like I said before, intravenous chemotherapy, which is usually given either for muscle-invasive bladder cancer, or a cancer that has spread to other sites with metastatic disease. But for the majority of patients who are getting just intravesical therapy, treatment within the bladder, I think it’s much less of a concern. But again, do let us know. And then the other thing is, so many of our patients are seeing us on a regular basis for the look inside the bladder in the office, cystoscopy, and we really encourage everybody to try to stay on schedule. We realize that there’s a lot of things that are out of our control, but it’s really important to keep up with follow-up, just like we would in normal times.

Rick Bangs:

Okay. So, here’s another one for both of you. Given the possibility of contracting COVID, and that bladder cancer patients tend to be older and therefore they’re at higher risk, how dangerous is getting cancer treatment, or testing, or what we just talked about, routine surveillance? Should we avoid them altogether, and how should patients decide on that?

Dr. Seth Lerner:

So, the easy answer to that is sort of what I was just talking about. We should all do our best, both the doctors and the nursing staff, and the patients, to try to keep patients on schedule to support them. We obviously work really, really hard to create a safe environment in the clinic and the hospital. We want patients, and their families, and loved ones, and caregivers, to feel confident that they can come into the healthcare environment and expect a high degree of safety. We take this very seriously.

And so it’s not just cancer, there’s other stuff going on, right? I mean, people get infections, they get pneumonia, they have heart disease, they have lung disease, all of those things. We should all be very meticulous about our care, and follow-up. If you have concerns, please reach out to your doctor and their staff, but we want people to get their cystos. We want them to get their imaging, we want them to get their treatment, and really try to stay on schedule. There’s, unfortunately, data across a broad spectrum of cancer types and treatment, that would suggest that those delays can be very counter-productive to the success of the treatment, and the long-term outcomes. So I think that in this pandemic, we are really trying our best to communicate that message, and like I said, to create as safe an environment as possible.

Dr. Woc-Colburn:

And I know that people have concerns about coming to our clinics. And one thing that we’ve learned from the COVID in the last year, is that the delaying care in many patients with their cancer, is sometimes worse. We have taken great deal of care on how to protect, not just the patient, but ourselves from getting COVID. I think those are the lessons that we learned early on. There are protocols. I mean, we clean the surface area, so you think the clinic is… I think the surface areas of my clinic are more sanitized than anywhere else in the world. That we probably can eat out of the floors because they’re cleaning every 30 minutes, but besides that, we use also mask.

And so we use our mask, us as a provider, and we use also eye protection, in order for you to be safe, that we’re not going to transmit it. We’ve also implemented a limited number of patients that can come into a clinic or a hospital. I’m here at Emory Healthcare, today I learned that we’re going to start relaxing that because our numbers are going down, but we still are not making sure that there’s like 30 people in to a room. So I think we’ve learned a lot, and it’s as safe as we can be, opposed to just waiting at home, and waiting for your cancer to continue festering there. Which is then worse, because then you’re actually going to need more care, radical therapies, and that’s not good.

Dr. Seth Lerner:

Yeah. I mean, I think Laila said something really important, that for the most part, we’re all vaccinated. We were very fortunate to be the first in line to get the vaccine. And then, of course, the whole purpose of this podcast in part is to encourage all of our patients to get vaccinated. So it should provide a high degree of safety and confidence, that you can go about more of your regular routine. Still with masks, still with social distancing, and of course we said before, if you’re symptomatic, please stay at home until that passes.

Rick Bangs:

Okay. So, if someone’s planning for home-care, or physical therapy after surgery or treatment, what should be considered relative to COVID, and relative to COVID vaccination?

Dr. Woc-Colburn:

So, again, the physical therapies fall into that first group of being vaccinated, right? So part of it is that, the other thing is that they should still wear the mask, and the eye protection, because we know that that minimizes the amount of transmission from one person to another. And a new part that has changed recently from the CDC, is that we’re encouraging people to wear double masks. So, your surgical mask underneath, and then you can wear a cloth mask on the top, and that gives you more protection. Still washing your hands, that’s because we touch surfaces, and sometimes cough into our hand, and that can be a part. And the social distance is a little harder from a physical therapist, but it’s also minimizing the number of people that are going to be coming to your home. And you can do your physical therapy in a well-ventilated… So the new part, instead of having more washing the hand, is having a well ventilated area, the double masking, and then you should be able to do it safely.

Dr. Seth Lerner:

Yeah. I mean, I think the other thing is that for the caregivers. Be it if they’re physical therapists, or if a patient needs a stay in a skilled nursing facility, and certainly for family members or loved ones that may be providing that care, to the extent that they should get vaccinated, right? That’s the other margin of safety. So, I think honestly, if I’m a patient in that setting, I’m going to ask some questions about, how is the facility, or the home health agency, handling that? Will they be relative to… What are their procedures, and are their staff vaccinated? I think those would be reasonable questions.

Rick Bangs:

So there’s been some interesting work done, both here and abroad, relative to testing BCG for healthcare workers. Are there any insights on whether BCG might reduce the risk of getting COVID, or dying from COVID?

Dr. Woc-Colburn:

So early on, BCG was seen… A study was done to see if the BCG vaccine had lower risk of contracting COVID-19. And part of that, it was because we were seeing less COVID patients in countries where BCG is administered when you’re in a young age. And so it seemed that individuals who were BCG vaccinated might have been less sick, or produce less antibodies, anti-SARS antibodies, or have mounted a more efficient. So, a study was proposed to do that. And I think Dr. Lerner was a part of it, right?

Dr. Seth Lerner:

Yeah. So I’ll… Listen, Laila is the infectious disease expert here. I’m just sort of drinking from the fire hose. So this is a really cool story, and the story has yet to be kind of fully told. But as Laila mentioned, in countries where there are national vaccination programs for TB, so BCG being related to the tuberculosis bacteria is sort of the perfect vaccine, it’s been around for decades, used globally for prevention of TB. So what they found, or what the data suggested, were that in countries that had a national vaccination program, there was a ten-fold lower risk of getting COVID, and a ten-fold lower risk of dying from COVID. So, what’s the potential explanation for that? So, as I understand it, there are a lot of non-specific immune effects from BCG vaccination. For instance, they showed that in one study, it could reduce the risk of yellow fever, which is another virally transmitted illness. And it sort of trains the immune system to recognize these foreign antigens, or foreign viruses.

So there were experts in the Netherlands and Australia who seized upon this. These are people whose life work is in the area of tuberculosis, and BCG vaccination, and they rapidly pivoted to do large studies of testing BCG vaccination as a potential preventive mechanism for COVID. Laila, I’m not aware that any of those studies have reported out. One of our colleagues at Baylor, who Laila knows quite well, Dr. Andrew DiNardo, also an expert in global tuberculosis and BCG testing, organized a group of, here at Baylor, MD Anderson, Texas A & M, and Cedar Sinai in Los Angeles, to do a large vaccination program, which is still ongoing. So in that study, it’s half the subjects get the vaccine, and half the subjects get a placebo, as the only way of really knowing if the vaccine works. Those studies are ongoing, and quite frankly, regardless of whether it shows a benefit or not, all of the other sort of parts of the research that are going on to look at how the immune system responds to BCG, specifically in the context of COVID, will shed a lot of light on it.

So, it’s really kind of cool stuff. I think a few of my patients have asked that, so Rick knows that we have a clinical trial where we’re testing BCG vaccination as a way to prime the immune system just before starting BCG. And we’ve had a number of patients ask us if that’s going to protect them from getting COVID, or just having BCG in the bladder can protect them. And I think the answer to that is, probably not. Now, if they happen to be in the vaccination arm, that remains to be seen. So, kind of an exciting offshoot of this whole pandemic.

Dr. Woc-Colburn:

Yeah. So, there are about 17 different studies, and actually the largest one is one called NUEVA. It’s not going to finish recruiting until 2023. I think this is where we’re going to have to see how it goes, until all the studies have gone, if there is protection from the BCG. Saying that, I can say that they have analyzed this. And for example, when you look at Latin America, versus Africa, versus Southeast Asia, and the rates of SARS-COV-2, you will see that is a disparity in Latin America. BCG is part of the vaccination, and so, but the numbers still are high, but compared to Africa, where we’re starting to see the numbers go up, but not to the rate that we saw everywhere else. And then, of course, then we have India, where we already have known that there’s more people who have been immune, have antibodies against COVID-2, but the numbers have not gone up. And so, I think it’s still… It’s going to be out there, and probably won’t know an answer until they finally close the studies in 2022, 2023.

Rick Bangs:

Thanks so much for your time, Drs. Lerner and Woc-Colburn. I’m certain our listeners will benefit from the information you’ve shared, and in case they wanted to get in touch with you, could you share your Twitter handle? Or any other information you would like people to have?

Dr. Woc-Colburn:

So, this is Dr. Woc-Culver. My Twitter handle is docwoc71. So, D-O-C-W-O-C, 7, 1. I also use that for my Instagram, and you can get information in English, as well in Spanish, for COVID related matters throughout. And I’m at Emory University and School of Medicine.

Dr. Seth Lerner:

So, I have to confess that I’m not on social media. It’s a bit safer for me, so I get all of my information through my wife and my children. But I’m at Baylor College of Medicine, in the Scott Department of Urology. And that’s the best way to reach me, there.

Rick Bangs:

That’s great. Thanks so much for this wonderful information. Just a reminder, if you would like more information about bladder cancer, you can contact the Bladder Cancer Advocacy Network at 1-888-901-2226. That’s all the time we have today. Thanks for listening, and we’ll be back soon with another interesting episode of Bladder Cancer Matters. Thanks again, Drs. Lerner and Woc-Colburn.

Dr. Woc-Colburn:

Thank you.

Dr. Seth Lerner:

Thank you, Rick. Appreciate it.

Voice over:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network, or BCAN. BCAN works to increase public awareness about bladder cancer, advance bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast, and additional information about bladder cancer, please visit B-C-A-N, dot, O-R-G.