Humanistic Burden of Radical Cystectomy (RC) Among Patients With Non-Muscle Invasive (NMIBC) or Non-Metastatic Muscle Invasive Bladder Cancer (MIBC): A Systematic Literature Review (SLR)

OBJECTIVES: Neoadjuvant chemotherapy followed by RC is the gold standard treatment in MIBC and selected high-risk NMIBC patients. RC can be a traumatic event, associated with substantial changes in daily living and health-related quality of life (HRQOL). Considering emerging bladder-preserving treatments, we evaluated evidence on the impact of RC on HRQOL.

METHODS: We conducted an SLR of English-language studies published 01/01/2001–05/09/2024 reporting HRQOL outcomes among patients with NMIBC or MIBC who underwent RC using MEDLINE, Embase, and Cochrane.

RESULTS: Among 98 identified studies, populations included NMIBC (7 studies), MIBC (43 studies), and mixed NMIBC/MIBC (48 studies). EORTC QLQ-C30, QLQ-BLM30, FACT-Bl/FACT-Bl-Cys/FACT-G/FBISI, SF-36, and Bladder Cancer Index were the most used instruments (42, 23, 20, 11, and 10 studies, respectively).

Most studies reported HRQOL deterioration and increased symptom burden post RC versus pre-RC baseline. HRQOL decline often partially or fully recovered >1 year post RC. Physical, social, and role functioning declined, while emotional functioning, cognitive functioning, and future perspectives improved or remained constant versus preoperative values. Studies consistently reported a decline in sexual function post RC that did not fully recover during follow-up.

HRQOL was worse among RC patients versus those treated with bladder-preserving treatments, particularly sexual function, fatigue, bowel symptoms, urinary symptoms, pain, and body image, whereas emotional functioning was better.

HRQOL was generally lower among RC patients versus non-cancer populations, particularly physical, social, role, and emotional functioning; however, few studies showed increased disease symptoms, plus decreased urinary and sexual function, with statistically non-significant differences in other functioning domains.

CONCLUSIONS: Despite heterogeneity in study designs and outcomes, patients showed a decline in HRQOL following RC compared with baseline, non-cancer populations, and non-RC patients with bladder cancer. Physical, role, social, and sexual functions, plus fatigue, bowel, and urinary symptoms, were often affected in RC patients, and did not always fully recover in the long term.