Jennifer M. Taylor, MD, MPH

Jennifer M. Taylor, MD, MPH

Houston, Texas

Baylor College of Medicine

Jennifer M. Taylor, MD, MPH, is an associate professor of urology and a practicing urologist at Baylor College of Medicine in Houston, Texas where she also serves as the residency program director for urology. Additionally, Dr. Taylor practices at the Michael E. DeBakey VA Medical Center where she is the director of urologic oncology for the VA urology service. Dr. Taylor earned her MD from the University of Texas Medical School in Houston, where she also completed an internship and residency, and she completed a fellowship in urologic oncology at Memorial Sloan Kettering Cancer Center in New York City. She also earned an MPH from the Harvard T.H. Chan School of Public Health in Boston.

Dr. Taylor is involved in clinical research in multiple genitourinary malignancies, with a focus on bladder cancer, as well as in research on medical education and physician wellness and resilience. Dr. Taylor is involved in the national medical community and is a member of the American Urological Association, the Society of Urologic Oncology, the Society of Women in Urology, and the American College of Surgeons. She has won numerous awards, including Baylor College of Medicine’s Norton Rose Fulbright Faculty Excellence Award for Teaching and Evaluation and the Women of Excellence Award.

Disclosures:

Talks by Jennifer M. Taylor, MD, MPH

Optimizing Perioperative Nutrition and Assessing Frailty

Jennifer M. Taylor, MD, MPH, discusses interventions for optimizing perioperative outcomes surrounding patient frailty and nutrition. Dr. Taylor begins by defining the causes of frailty and acknowledging that most cancer patients will have a certain level of frailty.

Dr. Taylor presents tools for the assessment of frailty that medical practitioners can use to evaluate frailty-based risks of invasive treatments. She notes that frail patients have a higher risk of mortality after surgery, and demonstrates a prototype of a Risk Analysis Index that is currently being trialed at multiple VA hospitals.

Dr. Taylor concludes by discussing the importance of having a multidisciplinary team that includes a dietician to support the frail patient pre- and post-operatively. She highlights that preoperative nutritional interventions, particularly in malnourished patients, are effective in reducing frailty in a short amount of time.

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2020 AUA Microhematuria Guidelines Update

Jennifer M. Taylor, MD, MPH, Assistant Professor of Urology at Baylor College of Medicine in Houston, Texas, begins by citing the original American Urological Association (AUA) Microhematuria Guideline from 2012, pointing out that the guideline was created in response to a major public health problem. She outlines the benefits and drawbacks of the original guideline, including the benefit that the AUA guideline would miss the fewest number of cancers versus other guidelines. The drawbacks included not being cost-effective, having low-yield and low specificity, being too aggressive for women and for those at low risk of malignancy, and having low rates of adherence. Dr. Taylor concludes that the 2012 guideline’s adverse impacts on patients were too great, citing discomfort, infections, false positives, and radiation exposure. Dr. Taylor then turns her discussion to the Microhematuria: AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline 2020, which took a risk-based, patient-centered approach, aiming to minimize harm and the waste involved in over-evaluation for low-risk patients, thereby improving specificity in those patients while maintaining specificity for those at higher risk for disease. Goals of the 2020 guideline included improving adherence with a more judicious set of guidelines and harmonizing the guidelines to achieve clarity among diverse stakeholders. The systematic review took place between January 2010 and December 2019 and included an evidence base of five systematic reviews and 91 primary literature studies. Dr. Taylor explains that the 2020 guideline maintains that microhematuria is defined as a urinalysis (UA) showing at least three red blood cells per high-powered field (≥ 3RBC/HPF). Dr. Taylor expounds upon the updated guidelines in terms of initial evaluation, diagnosis, and follow-up before confronting the gender gap in bladder cancer diagnosis. She cites a study concluding that treatment without further evaluation in the year prior to a bladder cancer diagnosis occurred 19 percent of the time in men versus 47 percent of the time in women. Further, there were three or more treatments for urinary tract infection (UTI) prior to evaluation by a urologist in 3.8 percent of men versus 15.8 percent of women. Dr. Taylor calls this significant and calls for continued advocacy for fuller symptom evaluation. Dr. Taylor then breaks down risk stratification, emphasizing that risk is highly correlated with known risk factors for urothelial cancer and doctors can tailor the intensity of the patient evaluation based on those risk factors. She presents and explains low-, medium-, and high-risk patient characteristics and evaluation recommendations. Dr. Taylor summarizes the takeaways from the 2020 guideline. For low-risk patients, practitioners should employ shared decision-making with their patients, either opting to repeat the UA or conduct a cystoscopy and renal ultrasound; for intermediate-risk patients, practitioners should conduct a cystoscopy and renal ultrasound; and for high-risk patients, the guideline recommends a cystoscopy with axial imaging. Dr. Taylor emphasizes the importance of the cystoscopy in these evaluations before displaying a summary one-page outline of the 2020 guideline and algorithm.

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Immunotherapy for NMIBC: Emerging and Expanding Indications

Jennifer M. Taylor, MD, MPH, Assistant Professor of Urology at Baylor College of Medicine in Houston, Texas, reviews new indications for immunotherapy for non-muscle invasive bladder cancer (NMIBC). She discusses the most common immunotherapy option, presents active clinical trials, and evaluates new treatment options. AUA guidance has previously stated that immunotherapy should be reserved for highest-risk NMIBC, and that for lower-risk cancer, patients and clinicians should weigh the benefit ratio when considering whether immunotherapy is an appropriate treatment choice given the possibility of adverse events. However, a shortage of the most common intravesical immunotherapy, bacillus Calmette-Guerin (BCG), in combination with increased numbers of BCG-unresponsive patients, have altered the treatment landscape. Dr. Taylor reviews the 2018 definition of BCG-unresponsive NMIBC and identifies several ways to determine whether a patient is BCG-unresponsive. Finally, she discusses the approval of pembrolizumab as a newly-available treatment for BCG-unresponsive NMIBC. In the study that led to the approval, 41% of patients had a complete response and no patients progressed to muscle invasive bladder cancer or metastasis. These favorable results are notable given that the gold-standard alternative is radical cystectomy. Additionally, pembrolizumab is well-tolerated and while adverse immune-related events are serious, they are rare and can be managed. Other treatments are also currently under investigation.

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Case-Based Panel Discussion: Muscle-Invasive Bladder Cancer

A. Edward Yen, MD; Jennifer M. Taylor, MD, MPH; Guilherme Godoy, MD, MPH; and Seth P. Lerner, MD, examine four unique case examples to elaborate on various treatment approaches for muscle-invasive bladder cancer (MIBC) based on individual patient needs. The panel discussion reviews current data on neoadjuvant chemotherapy, trimodal therapy, and checkpoint inhibitors in this setting.

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