Impact of late effects after treatment for bladder cancer with radical cystectomy on Quality of life: a case-control study

Authors

DOI:

https://doi.org/10.2340/1651-226X.2025.41040

Keywords:

Bladder cancer, late effects, quality of life, radical cystectomy

Abstract

Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient’s Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL.

Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only.

Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient’s Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL.

Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only.

Results: A total of 628 (54.3%) MIBC patients and their 1,204 (37.3%) matched controls responded. Median age was 73. Mean time since RC was 4.9 (SD 2.1) years. Scoring of the functional items on EORTC-QLQ-C30 and overall QoL were similar for cases and controls. Regarding late effects, similar responses were seen on questionnaire data when comparing cases and controls. On registry data, a higher risk of infections and hydronephrosis were seen for cases. A strong correlation between fatigue and impaired QoL was identified.

Interpretation: MIBC patients were more often diagnosed with late effects such as infections and hydronephrosis, compared to controls. In spite of this, MIBC patients overall QoL was equal to that of the controls.

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References

Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 guidelines. Eur Urol. 2023;85(1):17–31.

https://doi.org/10.1016/j.eururo.2023.08.016 DOI: https://doi.org/10.1016/j.eururo.2023.08.016

Westerman ME, Kokorovic A, Wang XS, Lim A, Garcia-Gonzalez A, Seif M, et al. Radical cystectomy and perioperative sexual function: a cross-sectional analysis. J Sex Med. 2020;17(10):1995–2004. https://doi.org/10.1016/j.jsxm.2020.06.015 DOI: https://doi.org/10.1016/j.jsxm.2020.06.015

Clay R, Shaunak R, Raj S, Light A, Malde S, Thurairaja R, et al. Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis. BJUI Compass. 2023;4(2):135–55. https://doi.org/10.1002/bco2.189 DOI: https://doi.org/10.1002/bco2.189

Grobet-Jeandin E, Pinar U, Parra J, Rouprêt M, Seisen T. Health-related quality of life after curative treatment for muscle-invasive bladder cancer. Nat Rev Urol. 2023;20(5):279–93. https://doi.org/10.1038/s41585-022-00693-z DOI: https://doi.org/10.1038/s41585-022-00693-z

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, 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. JNCI J Natl Cancer Instit. 1993;85(5):365–76. https://doi.org/10.1093/jnci/85.5.365 DOI: https://doi.org/10.1093/jnci/85.5.365

Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9. https://doi.org/10.1200/JCO.1993.11.3.570 DOI: https://doi.org/10.1200/JCO.1993.11.3.570

Ripping TM, Rammant E, Witjes JA, Aaronson NK, Van Hemelrijck M, Van Hoogstraten LMC, et al. Validation and reliability of the Dutch version of the EORTC QLQ-BLM30 module for assessing the health-related quality of life of patients with muscle invasive bladder cancer. Health Qual Life Outcomes. 2022;20(1):171. https://doi.org/10.1186/s12955-022-02064-z DOI: https://doi.org/10.1186/s12955-022-02064-z

Degboe A, Ivanescu C, Rohay JM, Turner RR, Cella D. Validity and performance of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) among advanced urothelial cancer patients. Support Care Cancer. 2019;27(11):4189–98. https://doi.org/10.1007/s00520-019-04709-0 DOI: https://doi.org/10.1007/s00520-019-04709-0

Greimel E, Nagele E, Lanceley A, Oberguggenberger AS, Nordin A, Kuljanic K, 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;154:235–45. https://doi.org/10.1016/j.ejca.2021.06.003 DOI: https://doi.org/10.1016/j.ejca.2021.06.003

Rogers Z, Glaser A, Catto JWF, Bottomley S, Jubber I, Kotwal S, et al. Health‐related quality of life after a diagnosis of bladder cancer: a longitudinal survey over the first year. BJU Int. 2024;133(4):460–73. https://doi.org/10.1111/bju.16242 DOI: https://doi.org/10.1111/bju.16242

Smith AB, Jaeger B, Pinheiro LC, Edwards LJ, Tan HJ, Nielsen ME, et al. Impact of bladder cancer on health‐related quality of life. BJU Int. 2018;121(4):549–57. https://doi.org/10.1111/bju.14047 DOI: https://doi.org/10.1111/bju.14047

Catto JWF, Downing A, Mason S, Wright P, Absolom K, Bottomley S, et al. Quality of life after bladder cancer: a cross-sectional survey of patient-reported outcomes. Eur Urol. 2021;79(5):621–32. https://doi.org/10.1016/j.eururo.2021.01.032 DOI: https://doi.org/10.1016/j.eururo.2021.01.032

Schmidt ME, Goldschmidt S, Hermann S, Steindorf K. Late effects, long‐term problems and unmet needs of cancer survivors. Int J Cancer. 2022;151(8):1280–90. https://doi.org/10.1002/ijc.34152 DOI: https://doi.org/10.1002/ijc.34152

Mak KS, Smith AB, Eidelman A, Clayman R, Niemierko A, Cheng JS, et al. Quality of life in long-term survivors of muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys. 2016;96(5):1028–36. https://doi.org/10.1016/j.ijrobp.2016.08.023 DOI: https://doi.org/10.1016/j.ijrobp.2016.08.023

Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;2015:449–90. https://doi.org/10.2147/CLEP.S91125 DOI: https://doi.org/10.2147/CLEP.S91125

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30. 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 Therapeut. 2016;44(7):693–703. https://doi.org/10.1111/apt.13746 DOI: https://doi.org/10.1111/apt.13746

Team RDC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2022.

Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. Brussels The EORTC QLQ-C30 scoring manual. 3rd ed. European Organisation for Research and Treatment of Cancer; 2001.

Cocks K, King MT, Velikova G, De Castro G, Martyn St-James M, Fayers PM, et al. Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Eur J Cancer. Brussels, 2012;48(11):1713–21. https://doi.org/10.1016/j.ejca.2012.02.059 DOI: https://doi.org/10.1016/j.ejca.2012.02.059

Kretschmer A, Grimm T, Buchner A, Jokisch F, Ziegelmüller B, Casuscelli J, et al. Midterm health-related quality of life after radical cystectomy: a propensity score-matched analysis. Eur Urol Focus. 2020;6(4):704–10. https://doi.org/10.1016/j.euf.2019.02.017 DOI: https://doi.org/10.1016/j.euf.2019.02.017

Fayers P, Weeden, S., Curran, D. EORTC QLQ–C30 reference values manual. European Organization for Research and Treatment of Cancer; 1998.

Segerstrom SC, Combs HL, Winning A, Boehm JK, Kubzansky LD. The happy survivor? Effects of differential mortality on life satisfaction in older age. Psychol Aging. 2016;31(4):340–5. https://doi.org/10.1037/pag0000091 DOI: https://doi.org/10.1037/pag0000091

Glaser AW. Resilience of men and the gap hypothesis of quality of life: health utility outcome measurement in prostate cancer. Eur Urol. 2019;76(6):752–3. https://doi.org/10.1016/j.eururo.2019.07.046 DOI: https://doi.org/10.1016/j.eururo.2019.07.046

Clements MB, Atkinson TM, Dalbagni GM, Li Y, Vickers AJ, Herr HW, et al. Health-related quality of life for patients undergoing radical cystectomy: results of a large prospective cohort. Eur Urol. 2022;81(3):294–304. https://doi.org/10.1016/j.eururo.2021.09.018 DOI: https://doi.org/10.1016/j.eururo.2021.09.018

Brandt SB, Kingo PS, Laurberg JR, Lam GW, Jensen JB. Definition of benign ureteroenteric anastomotic strictures in ileal conduits after radical cystectomy: experience from a single center and previously published literature. Urology. 2024;187:139. https://doi.org/10.1016/j.urology.2024.02.044 DOI: https://doi.org/10.1016/j.urology.2024.02.044

Jubber I, Rogers Z, Catto JW, Bottomley S, Glaser A, Downing A, et al. Sexual activity, function and dysfunction after a diagnosis of bladder cancer. J Sex Med. 2022;19(9):1431–41. https://doi.org/10.1016/j.jsxm.2022.06.016 DOI: https://doi.org/10.1016/j.jsxm.2022.06.016

Modh RA, Mulhall JP, Gilbert SM. Sexual dysfunction after cystectomy and urinary diversion. Nat Rev Urol. 2014;11(8):445–53. https://doi.org/10.1038/nrurol.2014.151 DOI: https://doi.org/10.1038/nrurol.2014.151

Pederzoli F, Campbell JD, Matsui H, Sopko NA, Bivalacqua TJ. Surgical factors associated with male and female sexual dysfunction after radical cystectomy: what do we know and how can we improve outcomes? Sex Med Rev. 2018;6(3):469–81. https://doi.org/10.1016/j.sxmr.2017.11.003 DOI: https://doi.org/10.1016/j.sxmr.2017.11.003

Gupta N, Kucirka LM, Semerjian A, Wainger J, Pierorazio PM, Herati AS, et al. Comparing provider-led sexual health counseling of male and female patients undergoing radical cystectomy. J Sex Med. 2020;17(5):949–56. https://doi.org/10.1016/j.jsxm.2020.01.025 DOI: https://doi.org/10.1016/j.jsxm.2020.01.025

Hupe MC, Vahlensieck W, Ozimek T, Struck JP, Hennig MJP, Tezval H, et al. Diarrhea and flatulence are major bowel disorders after radical cystectomy: Results from a cross-sectional study in bladder cancer patients. Urol Oncol. 2018;36(5):237.e1–.e8. https://doi.org/10.1016/j.urolonc.2017.12.014 DOI: https://doi.org/10.1016/j.urolonc.2017.12.014

Goldberg H, Baniel J, Mano R, Rotlevy G, Kedar D, Yossepowitch O. Orthotopic neobladder vs. ileal conduit urinary diversion: a long-term quality-of-life comparison. Urologic Oncology: Seminars and Original Investigations. 2016;34(3):121.e1–.e7. https://doi.org/10.1016/j.urolonc.2015.10.006 DOI: https://doi.org/10.1016/j.urolonc.2015.10.006

Asanad K, Nazemi A, Ghodoussipour S, Ladi-Seyedian S, Nassiri N, Wayne K, et al. Evaluation of bowel function following radical cystectomy and urinary diversion using two validated questionnaires: what are the effects on quality of life? Urology. 2021;156:279–84. https://doi.org/10.1016/j.urology.2021.04.044 DOI: https://doi.org/10.1016/j.urology.2021.04.044

Gellhaus PT, Cary C, Kaimakliotis HZ, Johnson CS, Weiner M, Koch MO, et al. Long-term health-related quality of life outcomes following radical cystectomy. Urology. 2017;106:82–6. https://doi.org/10.1016/j.urology.2017.03.053 DOI: https://doi.org/10.1016/j.urology.2017.03.053

Taarnhøj GA, Johansen C, Lindberg H, Basch E, Dueck A, Pappot H. Patient reported symptoms associated with quality of life during chemo‐ or immunotherapy for bladder cancer patients with advanced disease. Cancer Med. 2020;9(9):3078–87. https://doi.org/10.1002/cam4.2958 DOI: https://doi.org/10.1002/cam4.2958

Guo Z, Gu C, Li S, Gan S, Li Y, Xiang S, et al. Incidence and risk factors of suicide among patients diagnosed with bladder cancer: a systematic review and meta-analysis. Urol Oncol. 2021;39(3):171–9. https://doi.org/10.1016/j.urolonc.2020.11.022 DOI: https://doi.org/10.1016/j.urolonc.2020.11.022

Kulaksizoglu H, Toktas G, Kulaksizoglu IB, Aglamis E, Unlüer E. When should quality of life be measured after radical cystectomy? Eur Urol. 2002;42(4):350–5. https://doi.org/10.1016/S0302-2838(02)00351-2 DOI: https://doi.org/10.1016/S0302-2838(02)00351-2

Cerruto MA, D’Elia C, Cacciamani G, De Marchi D, Siracusano S, Iafrate M, et al. Behavioural profile and human adaptation of survivors after radical cystectomy and ileal conduit. Health Qual Life Outcomes. 2014;12(1):46. https://doi.org/10.1186/1477-7525-12-46 DOI: https://doi.org/10.1186/1477-7525-12-46

Aigner A, Grittner U, Becher H. Bias due to differential participation in case-control studies and review of available approaches for adjustment. PLoS One. 2018;13(1):e0191327. https://doi.org/10.1371/journal.pone.0191327 DOI: https://doi.org/10.1371/journal.pone.0191327

Additional Files

Published

2025-01-08

How to Cite

Milling, R. V., Nielsen, N. K., Graugaard-Jensen, C., Christensen, P., Pappot, H., & Jensen, J. B. (2025). Impact of late effects after treatment for bladder cancer with radical cystectomy on Quality of life: a case-control study. Acta Oncologica, 64, 27–33. https://doi.org/10.2340/1651-226X.2025.41040