ASTRO 2023: Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation

Over the last few years, trimodal therapy has emerged as a standard-of-care option for treating patients with muscle-invasive bladder cancer. A recent multicenter analysis by Zlotta et al. published in Lancet Oncology demonstrated that trimodal therapy was associated with comparable 5-year metastasis-free survival rates compared to radical cystectomy (~75%) in patients meeting the following eligibility criteria:¹

- Solitary tumors <7 cm
- No or unilateral hydronephrosis
- No extensive or multifocal carcinoma in situ

As such, patients are now presented with multiple treatment options for this disease. Accordingly, should the decision for one treatment versus the other be based on quality-of-life outcomes? To this end, Dr. Murthy and colleagues conducted a prospective cross-sectional study of 104 patients treated with either radical cystectomy (n=56) or bladder preservation therapy (n=48). All patients had cT1-4N0-1M0 urothelial carcinoma of the bladder and had a minimum of 6 months follow-up. Patients who were treated with palliative intent, had incomplete treatment, or had relapsed were excluded from the analysis. All patients had their quality-of-life outcomes assessed using the following instruments:

- EORTC QLQ-C30 version 3, which assesses:

• Global health scales
• Functional scales
• Symptoms scales

- Bladder Cancer Index, which assesses the following domains:

• Urinary
• Bowel
• Sexual

The baseline patient characteristics are summarized below. As this was a non-randomized study, there were imbalances in baseline patient demographics. Patients in the bladder preservation group were older (66 versus 60 years), had a worse comorbidity burden (52% versus 38%), and were less likely to have received perioperative chemotherapy (27% versus 48%). Of note, the time from treatment to quality-of-life check was significantly shorter in the bladder preservation therapy group (18 versus 31 months).

As determined via the EORTC QLQ C-30 scale, there were no significant differences between the two groups with regard to the functional, global health, and symptom scales, as demonstrated below:

There were similarly no significant differences in the urinary and bowel symptom scores, including function and bother, as assessed by the Bladder Cancer Index. However, overall sexual symptom scores and bother were both significantly better in the bladder preservation therapy group, as demonstrated in the rightmost panel below:

Based on the results of this study, the authors have launched the QOMPACT (Quality Of Life Measures after Bladder Preservation and Cystectomy) study that will prospectively compare longitudinal quality of life outcomes among 250 patients randomized to either trimodal therapy or radical cystectomy. 

Dr. Murthy concluded his presentation with the following take home messages:

- Overall, bladder cancer survivors have good quality-of-life outcomes
- There are no differences in urinary and bowel domains with radiotherapy and surgery
- Sexual bother scores are better with radiotherapy compared to radical cystectomy
- Quality-of-life should be central to the decision-making process

Presented by: Vedang Murthy, MD, DNB, DipEPP, Professor, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India

References:
1. Zlotta AR, Ballas LK, Niemierko A, et al. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol. 2023;24(6):669-81.