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Non-Muscle Invasive Bladder Cancer is Associated With Decreased Physical Health-Related Quality of Life

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Sources of Funding: none

Introduction

The effect of non-muscle invasive bladder cancer (NMIBC) on health-related quality of life (HRQOL) is poorly understood. We evaluated changes in HRQOL in patients with a new diagnosis of NMIBC compared with the general population using the Surveillance Epidemiology and End Results (SEER) Medicare Health Outcomes Survey (MHOS) database.

Methods

We identified 325 Medicare beneficiaries diagnosed with NMIBC between initial and 2-year follow-up using SEER-MHOS data (1998-2013). NMIBC patients who underwent cystoscopy with biopsy or transurethral resection of bladder tumor(s) for bladder cancer were propensity matched 1:5 to non-cancer controls (n=1685). Changes from baseline in the physical component score (PCS) and mental component score (MCS), which are normalized to between 0-100, where 50 represents the US population mean, were compared between NMIBC patients and non-cancer controls with χ2 testing and multivariate linear regression analysis. We secondarily assessed differences in urinary symptoms on post-diagnosis surveys with univariate and multivariate models.

Results

Pre-diagnosis, mean PCS (39.94 vs 39.54, p = 0.71) and mean MCS (52.03 vs 52.17, p = 0.82) scores were similar between NMIBC patients and matched non-cancer controls. Post-diagnosis, NMIBC patients had a significantly greater decrease in PCS compared with controls (-2.87 (95% CI -3.87, -1.86) vs. -1.47 (95% CI -1.93, -1.02), p = 0.02). Conversely, mean MCS change did not vary between groups (-1.79 (95% CI -2.76, -0.81) vs. -0.72 (95% CI -1.21, -0.23), p = 0.09). With respect to urinary function, NMIBC pts were more likely to have worsening of urinary leakage (38.0 % vs 18.7 %, p= < 0.01), require physician intervention for urinary symptoms (33.9 % vs 13.7 %, p= <0.01 ), and receive treatment for urine leakage (31.6 % vs 12.0 %, p= <0.01 ) compared with non-cancer controls (p = <0.01).

Conclusions

The diagnosis of NMIBC is associated with a significant decrease in physical HRQOL, including a significant impact on urinary symptoms and leakage. Further efforts to prospectively evaluate HRQOL in patients with NMIBC should be pursued to inform and improve patient counseling.

Funding

none

Authors
Wayne Brisbane
Sarah Holt
Brian Winters
John Gore
Atreya Dash
Michael Porter
Jonathan Wright
George Schade
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