Health-related quality of life in patients treated for non-metastatic muscle-invasive bladder cancer: radical cystectomy versus bladder preserving therapy.

Abstract

BACKGROUND

Patients with non-metastatic muscle-invasive bladder cancer (MIBC) can be treated with either radical cystectomy (RC) or bladder-preserving therapy (BPT). Contemporary data on the impact of these treatments on health-related quality of life (HRQOL) are lacking.

METHODS

In our prospective national cohort study, patients were invited to complete HRQOL questionnaires at baseline, 12 and 24 months after diagnosis. We included patients with non-metastatic MIBC, treated with either RC or BPT (chemoradiation or brachytherapy), who had completed at least one HRQOL questionnaire. HRQOL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30, version 3.0) and bladder cancer-specific symptoms were assessed using the EORTC-QLQ-Muscle-Invasive Bladder Cancer (QLQ-BLM30). We used linear mixed-effects models to analyse differences in HRQOL between the two treatment groups (range 0-100).

CONCLUSION

At two years, BPT and RC resulted in equal HRQOL scores in most domains. Sexual symptoms and functioning, body image and cognitive function were significantly better after BPT, RC resulted in better pain scores and emotional functioning. Insight into HRQOL outcomes can be used to guide shared decision making.

OBJECTIVE

To compare HRQOL between patients treated with BPT and RC.

RESULTS

292 patients completed the baseline questionnaire, 214 patients in the RC group and 78 in the BPT group. At 24 months, pain scores were lower and emotional function scores were higher in the RC group, with a between-group difference of -7.5 (95%CI -12.7 to -2.2) and 6.2 (95%CI 2.0 to 10.5), respectively. In contrast, cognitive function was higher in the BPT group, difference of -5.1 (95%CI -9.2 to -1.0). On the BLM30, sexual function and enjoyment scores were higher in the BPT group. Male sexual symptoms scores and body image scores were lower in the BPT group, differences were 25.6 (95%CI 11.2 to 39.9) and 9.3 (95%CI 4.2 to 14.4), respectively. There were no significant differences in gastro-intestinal symptoms. Difference in urinary symptoms could not be assessed due to 90% iliac conduits in the RC group.