OBJECTIVES

Patients with non-muscle invasive bladder cancer (NMIBC) undergo periodic cystoscopic surveillance as well as therapeutic interventions, including transurethral resection, intravesical therapy, and possibly radical cystectomy (RC). The impact of these interventions on patient health-related quality of life (HRQoL) add to the disease burden. This review aimed to identify and summarize literature assessing the HRQoL burden of NMIBC patients and of bladder cancer patients undergoing RC.

METHODS

A systematic review of literature in MEDLINE and Embase published between January 2007 and August 2017 and of conference proceedings published since 2015 was performed in accordance with established guidelines. Two reviewers independently screened and reviewed studies in English language from Europe, US, Canada, Japan, Australia and New Zealand.

RESULTS

The search yielded 1257 records. After exclusion of duplicates, screening and examination for relevance, 89 publications were identified. Thirteen studies assessed the HRQoL burden associated with NMIBC, while 76 assessed the burden associated with RC. Sixty-nine percent of studies had a prospective design. Thirty-nine different types of HRQoL instruments, mostly generic, were used. In US-focused studies (n = 29), bladder cancer-specific instruments (e.g. Bladder Cancer Index (n = 11)) were the most frequently used. NMIBC was associated with significant HRQoL reduction. Most studies reported an immediate and substantial decline in HRQoL post RC, particularly in physical, urinary and sexual domains with greater burden among younger patients. While many studies showed sustained decline, some suggested improvement to baseline values well after surgery; the latter was attributed to responder selection bias, and patients adapting to their new circumstances.

CONCLUSIONS

Considerable variation was observed in study design and in instrument choice. NMIBC impacts a patient’s quality of life adversely. It is further reduced immediately following RC, particularly in urinary and sexual function. HRQoL burden among NMIBC and RC patients in the US is understudied.