Presentation (CTI)

OBJECTIVES: Globally, radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) with or without systemic therapy; however, some patients are ineligible or decline RC. These patients are typically managed with bladder-preserving concurrent chemoradiotherapy using maximal transurethral resection of bladder tumor (cCRT/TMT), which carries substantial patient burden. This targeted review synthesized patient experience data (PED) for patients with MIBC undergoing bladder-sparing therapy.
METHODS: Publications reporting PED in MIBC associated with cCRT/TMT or related bladder-sparing approaches were identified in MEDLINE (January 2015-January 2026). Outcomes were summarized by PED type: disease symptoms, treatment and disease burden, HRQOL impacts, and patient preferences.
RESULTS: Of 463 identified records, 17 met inclusion criteria (15 quantitative; 2 qualitative). Disease symptoms: Patients reported consistent, substantial symptom burden spanning urinary, bowel, sexual, physical, and psychological domains, including hematuria, urinary frequency, incontinence, bowel-control problems, pain, and impaired erectile function. Treatment and disease burden: Treatment burden extended beyond symptoms, encompassing high healthcare utilization, repeated invasive procedures, prolonged treatment, and worsening psychological sequelae. Posttreatment complications (e.g., hematuria, urinary dysfunction, diarrhea, fatigue, and sexual dysfunction) were common and persistent. HRQOL impacts: HRQOL declined during active cCRT/TMT, recovering toward baseline within 6 months in most relapse-free survivors. Fatigue and urinary symptoms persisted long-term. Meaningful functional burden (i.e., sexual dysfunction) remained, underscoring that bladder preservation does not equate to burden-free survival. Patient preferences: Treatment decisions for MIBC were driven by perceived survival benefit, expected impact on HRQOL, and clinician recommendation. Patients prioritized bladder preservation, sexual function, and treatment duration and setting, with shared decision-making favoring bladder-sparing approaches to maintain body image and independence and avoid urinary diversion-related complications.
CONCLUSIONS: Current literature indicates bladder-sparing therapy (cCRT/TMT) in MIBC imposes meaningful and persistent patient burden. However, PED directly capturing the lived cCRT/TMT experience (particularly qualitative evidence and longitudinal data beyond 2 years) remains sparse.