The Impact of Intravesical Instillations on Quality of Life in Patients With Non-Muscle Invasive Bladder Cancer (NMIBC)
Author(s)
Ingolf Griebsch, MPH, MSc, PharmD, PhD1, Sunil Shrestha, PharmD, PhD2, Yair Lotan, MD3, Chi-Fai Ng, MD4, Andrew BOTTOMLEY, PhD5.
1Health Economics & Outcome Research (HEOR), Ferring Pharmaceuticals Inc., Frankfurt, Germany, 2Kathmandu Cancer Center, Bhaktapur, Nepal, 3Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA, 4Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong, 5Director, Bottomley Consulting Group, Brussels, Belgium.
1Health Economics & Outcome Research (HEOR), Ferring Pharmaceuticals Inc., Frankfurt, Germany, 2Kathmandu Cancer Center, Bhaktapur, Nepal, 3Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA, 4Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong, 5Director, Bottomley Consulting Group, Brussels, Belgium.
OBJECTIVES: Non-Muscle Invasive Bladder Cancer (NMIBC) is commonly treated with transurethral resection of bladder tumor (TURBT) followed by intravesical chemotherapy and/or Bacillus Calmette-Guérin (BCG) instillations. While these treatments aim to prevent recurrence and progression, they may impact on patients’ quality of life (QOL), particularly due to treatment frequency and associated side effects. We systematically reviewed the impact of intravesical instillations of BCG and chemotherapy on QOL in NMIBC patients, with a specific focus on the influence of instillation frequency on treatment adherence and withdrawal rates.
METHODS: A systematic review was conducted following PRISMA guidelines. Over 750 individual abstracts were independently screened by two independent reviewers. Studies published between 2005 and 2024 were included in this review. Data extraction encompassed study demographics, treatment protocols, QOL outcomes, and adherence rates. Risk of bias assessments were undertaken to assess the quality of the studies.
RESULTS: Seventeen studies were selected comprising six qualitative studies, eight quantitative studies, and three mixed-methods studies covering qualitative and quantitative findings. A total of 20,045 patients were recruited in the included 17 studies. Frequent instillations were associated with increased urinary symptoms (e.g., urgency, dysuria), fatigue, and emotional distress. Withdrawal rates were high (up to 90%) in intensive schedules, particularly during the first year, due to treatment burden and side effects.
CONCLUSIONS: Frequent intravesical instillations are associated with a significant burden on QOL, affecting both physical and emotional well-being. It is very possible that emerging therapies with less intensive treatment schedules could show promise in minimizing treatment burden while maintaining effective disease control, offering potential QOL benefits for NMIBC patients.
METHODS: A systematic review was conducted following PRISMA guidelines. Over 750 individual abstracts were independently screened by two independent reviewers. Studies published between 2005 and 2024 were included in this review. Data extraction encompassed study demographics, treatment protocols, QOL outcomes, and adherence rates. Risk of bias assessments were undertaken to assess the quality of the studies.
RESULTS: Seventeen studies were selected comprising six qualitative studies, eight quantitative studies, and three mixed-methods studies covering qualitative and quantitative findings. A total of 20,045 patients were recruited in the included 17 studies. Frequent instillations were associated with increased urinary symptoms (e.g., urgency, dysuria), fatigue, and emotional distress. Withdrawal rates were high (up to 90%) in intensive schedules, particularly during the first year, due to treatment burden and side effects.
CONCLUSIONS: Frequent intravesical instillations are associated with a significant burden on QOL, affecting both physical and emotional well-being. It is very possible that emerging therapies with less intensive treatment schedules could show promise in minimizing treatment burden while maintaining effective disease control, offering potential QOL benefits for NMIBC patients.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR232
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance, Patient-reported Outcomes & Quality of Life Outcomes
Disease
Generics, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology