HRQOL Finds Similar Responses Between Surgery/Treatment Options in NMIBC

HRQOL scores were similar among patients who received a radical cystectomy or bladder persevering therapy for non-muscle invasive bladder cancer.

Health-related quality of life (HRQOL) scores across most domains for patients with non-metastatic muscle-invasive bladder cancer receiving bladder preserving therapy (BPT) or radical cystectomy (RC) were similar, according to results from a study published in the International Journal of Radiation Oncology.

The EORTC-QLQ-C30 scores at baseline, 12 months, and 24 months after diagnosis:

• Functional scales
  • Global health
    • RC: 74.47 (95% CI, 72.23-76.70); 79.29 (95% CI, 76.80-81.79); 80.56 (95% CI, 77.74-83.38)
    • BPT: 75.53 (95% CI, 71.92-79.15); 79.86 (95% CI, 75.80-83.93); 81.01 (95% CI, 76.51-85.51)
  • Physical
    • RC: 87.19 (95% CI, 84.89-89.48); 83.62 (95% CI, 81.12-86.12); 84.16 (95% CI, 81.41-86.91)
    • BPT: 82.44 (95% CI, 78.71-86.16); 80.90 (95% CI, 76.83-84.97) 80.67 (95% CI, 76.30-85.03)
  • Emotional
    • RC: 82.12 (95% CI, 79.85-84.40); 89.93 (95% CI, 87.37-92.49); 93.22 (95% CI, 90.29-96.15)
    • BPT: 82.69 (95% CI, 79.01-86.37); 87.71 (95% CI, 83.54-91.89); 88.99 (95% CI, 84.34-93.63)
• Symptom scales
  • Fatigue
    • RC: 23.37 (95%CI, 20.56-26.17); 19.71 (95% CI, 16.55-22.87); 18.36 (95% CI, 14.73-21.98)
    • BPT: 24.07 (95% CI, 19.54-28.61); 21.29 (95% CI, 16.14-26.44); 18.68 (95% CI, 12.93-24.43)
  • Nausea/Vomiting
    • RC: 5.47 (95% CI, 4.06-6.89); 2.20 (95% CI, 0.57-3.84); 1.96 (95% CI, 0.01-3.90)
    • BPT: 4.49 (95% CI, 2.20-6.77); 1.51 (95% CI, –1.16 to 4.18); 0.75 (95% CI, −2.31 to 3.82)
  • Pain
    • RC: 17.24 (95% CI, 14.51-19.97); 11.29 (95% CI, 8.20-14.38); 8.24 (95% CI, 4.69-11.79)
    • BPT: 14.74 (95% CI, 10.33-19.16); 14.74 (95% CI, 10.33-19.16); 11.50 (95% CI, 5.87-17.13)

Investigators also assessed the estimated adjusted marginal mean difference between RC and BPT at baseline, 12 months, and 24 months. There was a positive difference in functioning scores and negative difference in symptom scores which favor RC. The better score in the BPT group which was highlighted was cognitive and was 1.52 (95% CI, –2.82 to 5.85; P = .492) at baseline, –5.69 (95% CI, –9.27 to –2.11; P = .002) at 12 months, and –5.10 (95% CI, –9.18 to –1.02; P = .015) at 24 months, the latter 2 of which were clinically relevant. The better score in the RC group was for pain and was 1.05 (95% CI, –4.34 to 6.45; P = .701) at baseline, –4.87 (95% CI, –9.42 to –0.32; P = .036) at 12 months, and –7.45 (95% CI, –12.66 to –2.23; P = .005) at 24 months, the latter of which was clinically relevant.

The adjusted scores with the BLM30 domain and the 3 timepoints found that at 12- and 24-months post diagnosis there was no significant difference in the adjusted bloating and flatulence scores. At 12 months, the adjusted sexual intimacy symptom score was higher in the RC group of 11.8 (95% CI, 3.9-19.7) and at 24 months there was no significant difference in favor of RC with –8.7 (95% CI, –18.6 to 1.2). In the RC group, the adjusted male sexual problem score was higher at 24 months with a difference of 25.6 (95% CI, 11.2-39.9). For female sexual problems, they could not reliably be followed up because of the small number of female participants. Of note, the adjusted sexual functioning scores were better in the BPT group than the RC group at 24 months with –7.7 (95% CI, –13.4 to –2.0).

Investigators noted that a direct comparison of urinary symptoms between groups was not possible because different questions apply, with the scores being presented by treatment group over time. In the BPT group it was 32.1 (95% CI, 28.2-35.9) at baseline, 18.6 (95% CI, 14.4-22.9) at 12 months, and 24.2 (95% CI, 19.5-28.8) at 24 months. In the RC group the scores were 5.0 (95% CI, –9.2 to 19.3) at 12 months and 14.9 (95% CI, –2.5 to 32.2) at 24 months.

“In this contemporary longitudinal cohort study, we compared HRQOL at 12 and 24 months after bladder cancer diagnosis, in patients treated with either RC or BPT. Sexual functioning and body image scores were significantly better after BPT than after RC. In addition, patients in the BPT group had better cognitive function. Treatment with RC resulted in improved pain and better emotional functioning at 24 months as compared with BPT,” Katharina Brück, MD, a researcher in the Department of Research at the Netherlands Comprehensive Cancer Organisation, and co-authors wrote in the study.

The 1432 patients were selected from the Comparison of Radical Cystectomy and Chemoradiation group with 797 being diagnosed in participating hospitals with the HRQOL study, and were invited to complete it. Overall, 381 patients completed the first questionnaire but 89 were excluded because it was completed after the date of RC or 2 or more weeks after their first radiation therapy. The pretreatment questionnaire was completed by 292 patients, and 210 returned more than 1 follow-up questionnaire.

Most patients were male (79.5%), 69.4 years old at diagnosis, had an ECOG performance status of 0 (47.3%), and a tumor size that was unknown (67.1%).

Reference

Brück K, Atema V, Leliveld AM, et al. Health-related quality of life in patients treated for nonmetastatic muscle-invasive bladder cancer: radical cystectomy versus bladder-preserving therapy. Int J Radiat Oncol Biol Phys. 2025;123(4):1004-1017. doi:10.1016/j.ijrobp.2025.06.3866