Long-term effect of treatment for non-muscle invasive bladder cancer on Quality of life: a cross-sectional study
DOI:
https://doi.org/10.2340/sju.v60.44187Keywords:
Bladder cancer, complications, quality of lifeAbstract
Background and objective: Approximately 75% of bladder cancer patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). Complications from treatment, burden the patients and may affect their Quality of Life (QoL). Although accounting for most bladder cancer patients, only 25% of QoL research is conducted in NMIBC patients. The aim is to describe the incidence of complications and to investigate their long-term impact on QoL.
Methods: This is a cross-sectional study using register data combined with a questionnaire, measuring urological, sexual, gastrointestinal, and psychological complications during treatment. The NMIBC patients diagnosed in Denmark from 2015 to 2020 with the ability to receive digital mail were invited to participate along with 1:6 age- and gender-matched controls. The survey mainly consisted of the European Organisation for Research and Treatment of Cancer’s (EORTC) EORTC-QLQ-C30 and the NMIBC specific EORTC-QLQ-NMIBC24.
Results: A total of 2262 (43%) NMIBC-patients and their 4092 (36%) matched controls participated. Mean time since last Transurethral Resection of Bladder Tumour was 5.8 years (SD: 2.2). Both cases and controls scored equally on the functional items and symptom items of the EORTC-QLQ-C30. The scoring by NMIBC-patients of the EORTC-QLQ-NMIBC24 were mild, indicating no symptomatology. No difference in register-based diagnoses was identified, except for higher incidences of infections related to the urinary tract identified in NMIBC patients.
Conclusions: We found that NMIBC patients have higher incidences of urological diagnoses compared to controls, but not in sexual or gastrointestinal diagnoses. No difference in long-term impact of complications on QoL between NMIBC patients and controls were identified.
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Jubber I, Ong S, Bukavina L, et al. Epidemiology of bladder cancer in 2023: a systematic review of risk factors. Eur Urol. 2023; 84(2): 176–190. https://doi.org/10.1016/j.eururo.2023.03.029 DOI: https://doi.org/10.1016/j.eururo.2023.03.029
Babjuk M, Burger M, Capoun O, et al. European Association of Urology guidelines on nNon-muscle-invasive bladder cancer (Ta, T1, and Carcinoma in Situ). Eur Urol. 2022; 81(1): 75–94. https://doi.org/10.1016/j.eururo.2021.08.010 DOI: https://doi.org/10.1016/j.eururo.2021.08.010
DaBlaCa D. National clinical guidelines for treating bladder cancer in Denmark 2023 [Internet]. 2024. Available from: https://www.dmcg.dk/Kliniske-retningslinjer/kliniske-retningslinjer-opdelt-paa-dmcg/cancer-i-urinvejene/blaerecancer/ [cited June 2024]
Krajewski W, Halska U, Poletajew S, et al. Influence of transurethral resection of bladder cancer on sexual function, anxiety, and depres-sion. Adv Exp Med Biol. 2018; 1116: 37–50. https://doi.org/10.1007/5584_2018_264 DOI: https://doi.org/10.1007/5584_2018_264
Deacon NN, Nielsen NK, Jensen JB. Patient-reported outcomes after laser ablation for bladder tumours compared to transurethral resec-tion—a prospective study. Cancers. 2024; 16(9): 1630. https://doi.org/10.3390/cancers16091630 DOI: https://doi.org/10.3390/cancers16091630
Jung A, Nielsen ME, Crandell JL, et al. Quality of life in non-muscle-invasive bladder cancer survivors: a systematic review. Cancer Nurs. 2019; 42(3): E21–e33. https://doi.org/10.1097/NCC.0000000000000606 DOI: https://doi.org/10.1097/NCC.0000000000000606
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Instit. 1993; 85(5): 365–376. https://doi.org/10.1093/jnci/85.5.365 DOI: https://doi.org/10.1093/jnci/85.5.365
Blazeby JM, Hall E, Aaronson NK, et al. Validation and reliability testing of the EORTC QLQ-NMIBC24 questionnaire module to assess pa-tient-reported outcomes in non-muscle-invasive bladder cancer. Eur Urol. 2014; 66(6): 1148–1156. https://doi.org/10.1016/j.eururo.2014.02.034 DOI: https://doi.org/10.1016/j.eururo.2014.02.034
Rammant E, Fox L, Beyer K, et al. The current use of the EORTC QLQ-NMIBC24 and QLQ-BLM30 questionnaires for the assessment of health-related quality of life in bladder cancer patients: a systematic review. Qual Life Res. 2023; 32(8): 2127–135. https://doi.org/10.1007/s11136-022-03335-4 DOI: https://doi.org/10.1007/s11136-022-03335-4
Wei L, Li Q, Liang H, et al. The quality of life in patients during intravesical treatment and correlation with local symptoms. J Chemother. 2014; 26(3): 165–168. https://doi.org/10.1179/1973947813Y.0000000126 DOI: https://doi.org/10.1179/1973947813Y.0000000126
Schmidt M, Schmidt SAJ, Sandegaard JL, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015; 2015: 449–490. https://doi.org/10.2147/CLEP.S91125 DOI: https://doi.org/10.2147/CLEP.S91125
Gilbert A, Piccinin C, Velikova G, et al. Linking the European Organisation for Research and Treatment of Cancer item library to the com-mon terminology criteria for adverse events. J Clin Oncol. 2022; 40(32): 3770–3780. https://doi.org/10.1200/JCO.21.02017 DOI: https://doi.org/10.1200/JCO.21.02017
Abrams P, Avery K, Gardener N, et al. The international consultation on incontinence modular questionnaire: www.iciq.net. J Urol. 2006;175(3 Pt 1):1063–1066; discussion 1066. https://doi.org/10.1016/S0022-5347(05)00348-4 DOI: https://doi.org/10.1016/S0022-5347(05)00348-4
Greimel E, Nagele E, Lanceley A, et al. Psychometric validation of the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). Eur J Cancer. 2021; 154: 235–245. https://doi.org/10.1016/j.ejca.2021.06.003 DOI: https://doi.org/10.1016/j.ejca.2021.06.003
Neijenhuijs KI, Holtmaat K, Aaronson NK, et al. The International Index of Erectile Function (IIEF) – a systematic review of measurement properties. J Sex Med. 2019; 16(7): 1078–1091. https://doi.org/10.1016/j.jsxm.2019.04.010 DOI: https://doi.org/10.1016/j.jsxm.2019.04.010
Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997; 49(6): 822–830. https://doi.org/10.1016/S0090-4295(97)00238-0 DOI: https://doi.org/10.1016/S0090-4295(97)00238-0
Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome. Aliment Pharmacol Therap. 2016; 44(7): 693–703. https://doi.org/10.1111/apt.13746 DOI: https://doi.org/10.1111/apt.13746
Charlson ME, Carrozzino D, Guidi J, et al. Charlson Comorbidity Index: a critical review of clinimetric properties. Psychother Psychosom. 2022; 91(1): 8–35. https://doi.org/10.1159/000521288 DOI: https://doi.org/10.1159/000521288
Team RDC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2022.
Fayers PM AN, Bjordal K, Groenvold M, et al. The EORTC QLQ-C30 scoring manual. 3rd ed. European Organisation for Research and Treat-ment of Cancer: Brussels, Belgium;2001.
Van Straten C, Caris C, Grimm MO, et al. Quality of life in patients with high-grade non-muscle-invasive bladder cancer undergoing stand-ard versus reduced frequency of Bacillus Calmette-Guérin instillations: the EAU-RF NIMBUS trial. Eur Urol Open Sci. 2023; 56: 15–24. https://doi.org/10.1016/j.euros.2023.08.004 DOI: https://doi.org/10.1016/j.euros.2023.08.004
González-Padilla DA, González-Díaz A, Guerrero-Ramos F, et al. Quality of life and adverse events in patients with nonmuscle invasive bladder cancer receiving adjuvant treatment with BCG, MMC, or chemohyperthermia. Urol Oncol. 2021; 39(1): 76.e9–76.e14. https://doi.org/10.1016/j.urolonc.2020.07.003 DOI: https://doi.org/10.1016/j.urolonc.2020.07.003
Beeren I, Klerks NE, Aben KK, et al. Health-related quality of life during the first 4 years after non-muscle-invasive bladder cancer diagno-sis: results of a large multicentre prospective cohort. Eur Urol Oncol. 2023; 7(4): 829–837. https://doi.org/10.1016/j.euo.2023.11.007 DOI: https://doi.org/10.1016/j.euo.2023.11.007
Giesinger JM, Loth FLC, Aaronson NK, et al. Thresholds for clinical importance were established to improve interpretation of the EORTC QLQ-C30 in clinical practice and research. J Clin Epidemiol. 2020; 118: 1–8. https://doi.org/10.1016/j.jclinepi.2019.10.003 DOI: https://doi.org/10.1016/j.jclinepi.2019.10.003
Gregg JR, McCormick B, Wang L, et al. Short term complications from transurethral resection of bladder tumor. Can J Urol. 2016;23(2):8198–8203.
Bolat D, Çelik S, Aydın ME, et al. Assessment of the quality of life and sexual functions of patients followed-up for non-muscle invasive bladder cancer: preliminary results of the prospective-descriptive study. Turk J Urol. 2018; 44(5): 393–398. https://doi.org/10.5152/tud.2018.30040 DOI: https://doi.org/10.5152/tud.2018.30040
Kowalkowski MA, Chandrashekar A, Amiel GE, et al. Examining sexual dysfunction in non-muscle-invasive bladder cancer: results of cross-sectional mixed-methods research. Sex Med. 2014; 2(3): 141–151. https://doi.org/10.1002/sm2.24 DOI: https://doi.org/10.1002/sm2.24
Van Der Aa MNM, Bekker MD, Van Der Kwast TH, et al. Sexual function of patients under surveillance for bladder cancer. BJU Int. 2009; 104(1): 35–40. https://doi.org/10.1111/j.1464-410X.2008.08333.x DOI: https://doi.org/10.1111/j.1464-410X.2008.08333.x
Jung A, Nielsen ME, Crandell JL, et al. Health‐related quality of life among non‐muscle‐invasive bladder cancer survivors: a population‐based study. BJU Int. 2020; 125(1): 38–48. https://doi.org/10.1111/bju.14888 DOI: https://doi.org/10.1111/bju.14888
Vidra N, Beeren I, Van Zutphen M, et al. Longitudinal associations of adherence to lifestyle recommendations and health-related quality of life in patients with non-muscle invasive bladder cancer. Int J Cancer. 2023; 152(10): 2032–2042. https://doi.org/10.1002/ijc.34418 DOI: https://doi.org/10.1002/ijc.34418
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Copyright (c) 2025 Rikke Vilsbøll Milling, Ninna Kjær Nielsen, Charlotte Graugaard-Jensen, Peter Christensen, Helle Pappot, Jørgen Bjerggaard Jensen
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