Health-related Quality of Life During the First 4 Years After Non-Muscle-invasive Bladder Cancer Diagnosis: Results of a Large Multicentre Prospective Cohort

Ivy Beeren; Nena E Klerks; Katja K Aben; Jorg R Oddens; J Alfred Witjes; Lambertus A Kiemeney; Alina Vrieling

doi:10.1016/j.euo.2023.11.007

Health-related Quality of Life During the First 4 Years After Non-Muscle-invasive Bladder Cancer Diagnosis: Results of a Large Multicentre Prospective Cohort

Eur Urol Oncol. 2023 Nov 22:S2588-9311(23)00252-3. doi: 10.1016/j.euo.2023.11.007. Online ahead of print.

Authors

Ivy Beeren¹, Nena E Klerks¹, Katja K Aben², Jorg R Oddens³, J Alfred Witjes⁴, Lambertus A Kiemeney⁵, Alina Vrieling⁶

Affiliations

¹ Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
² Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
³ Department of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Alina.Vrieling@radboudumc.nl.

PMID: 37996278
DOI: 10.1016/j.euo.2023.11.007

Abstract

Background: The health-related quality of life (HRQoL) of patients with non-muscle-invasive bladder cancer (NMIBC) may be impaired due to the chronic and burdensome disease course, but longitudinal data are limited.

Objective: To evaluate HRQoL outcomes during the first 4 yr after NMIBC diagnosis, and to compare HRQoL across patient characteristics and with a normative population.

Design, setting, and participants: Patients with NMIBC (n = 1019) were included from the multicentre prospective cohort UroLife. Data were collected at 6 wk (baseline), and 3, 15, and 51 mo after diagnosis. Longitudinal reference data were obtained from an age- and sex-matched normative population (n = 490).

Outcome measurements and statistical analysis: Cancer- and NMIBC-specific HRQoL outcomes (range 0-100) were evaluated by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-NMIBC24 questionnaires, respectively. Linear mixed modelling was used to analyse within-group changes and between-group differences.

Results and limitations: The majority of HRQoL outcomes remained stable over time. Observed changes were only of small clinical relevance. Improvements were noted in insomnia, social functioning, and three NMIBC-specific symptoms, while minor deteriorations in appetite and diarrhoea lasted until 51 mo. HRQoL in some domains was worse for high-grade NMIBC, high European Association of Urology (EAU) risk group, initial Bacillus Calmette-Guérin (BCG) treatment, being female, and being younger (<65 yr); yet differences were few, small, and temporary. No differences were observed across recurrence status. Compared with a normative population, clinically relevant worse scores were observed for six of 15 outcomes, which mostly recovered at 51 mo, except for minor symptoms of appetite loss and diarrhoea.

Conclusions: No remarkable changes in HRQoL were observed during the first 4 yr after NMIBC diagnosis. Grade, EAU risk group, initial treatment, recurrence, sex, and age did not importantly affect HRQoL. HRQoL was largely comparable with that of the general population, especially after 4 yr.

Patient summary: Quality of life is not largely affected during the first 4 yr after non-muscle-invasive bladder cancer diagnosis.

Keywords: Health-related quality of life; Non–muscle-invasive bladder cancer; Patient-reported outcomes.