The impact of treatment for muscle-invasive bladder cancer on health-related quality of life

OBJECTIVES: To evaluate the impact of treatment for localised muscle-invasive bladder cancer (MIBC) during the first 2 years after diagnosis.

PATIENTS AND METHODS: A prospective cohort study was conducted including patients diagnosed with non-metastatic (cM0) MIBC between November 2017 and November 2019 in the Netherlands. Health-related quality of life (HRQoL) was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) as well as the MIBC-specific QLQ-BLM30 module. Questionnaires were administered at baseline (pre-treatment) and at 6, 12 and 24 months after diagnosis. Patients were grouped by treatment: neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), upfront RC, chemoradiation, and radiotherapy. Linear mixed models were used to assess HRQoL changes over time per treatment group.

RESULTS: A total of 518 patients participated in quality of life measurements (46% response rate). After excluding 14 patients who did not complete the EORTC QLQ-C30 and 114 for baseline completion after start of treatment, a total of 390 patients were included of whom 105 underwent NAC and RC, 148 underwent upfront RC, 58 underwent chemoradiation, and 79 underwent radiotherapy alone. Over time, clinically relevant improvements in emotional functioning and future perspective were observed across all treatment groups. However, a temporary worsening in physical functioning was observed at 6 months. Patients treated with RC (with or without NAC) experienced persistent deteriorations in body image and sexual functioning up to at least 2 years after diagnosis, although urostomy-related outcomes improved. Patients undergoing chemoradiation showed improvements in urinary symptoms, while those receiving radiotherapy reported significant worsening of dyspnoea over time.

CONCLUSION: In this largest population-based study to date on HRQoL in MIBC, HRQoL largely recovered to baseline levels during the first 2 years after diagnosis. However, persistent deteriorations in physical and cognitive functioning, body image, and sexual function were observed, particularly in patients treated with RC (with or without NAC).