EDITORIAL COMMENT

Abstract

In the study “Nonmuscle Invasive Bladder Cancer Influences Physical Health Related Quality of Life and Urinary Incontinence, Wayne G. Brisbane and colleagues examine patient-reported quality of life (QOL) and urinary incontinence outcomes associated with the diagnosis and management of nonmuscle invasive bladder cancer. The study is based on SEER cancer registry data linked to patient-reported outcomes (PROs) data collected as part of the Medical Health Outcomes Survey (SEER-MHOS), which allowed the authors to not only evaluate patient-reported outcomes in a representative sample of bladder cancer patients managed with endoscopic and intravesical treatments, but also benchmark those outcomes to surveys taken from noncancer controls who participated in MHOS as part of their Medicare Advantage plan. Though changes in patient-reported QOL and urinary function were apparent in both groups, declines in PRO scores were more pronounced among NMIBC patients than in noncancer controls. For example, SF-36 physical component summary (PCS) scores decreased by 3.0 points among bladder cancer patients from before diagnosis to after treatment (assessments were performed at 2 year intervals according to MHOS assessment frames) but only 1.5 in the control group (P = .01). Similarly, problems with urinary incontinence were more commonly reported by patients than controls; 15.2% of NMIBC patient respondents endorsed new urinary incontinence compared to 11.2% of controls (P = .09), and 20.0% of patients reported increased severity of incontinence compared to 11.4% of controls (P <.01). Notably, significant deficits in physical health and QOL were driven primarily by low scores in high-risk NMIBC cases (high-grade Ta disease, CIS, and T1 disease), implicating a close association between frequent interventions, such as repeated cystoscopy, biopsy, resection and intravesical therapies, and poorer patient-reported outcomes. Although these results may not be surprising and likely confirm the observations of practicing urologists who often manage bladder cancer, they provide empirical evidence that quantifies the burdens associated with the diagnosis and treatment of NMIBC. Moreover, these data have several palpable implications in my opinion. First, they represent a step forward and knowledge gained; they pencil in previously undescribed details about patient-reported symptoms and QOL outcomes within the outlines of a relatively understudied area. Second, they underscore the importance of PROs and QOL assessments among bladder cancer patients managed with endoscopic and intravesical therapies, which is particularly relevant given the exploding number of clinical trials evaluating emerging NMIBC therapies that are currently underway. 1 Nykopp TK Batista da Costa J Mannas M Black PC Current clinical trials in non-muscle invasive bladder cancer. Curr Urol Rep. 2018; 19: 101 Crossref PubMed Scopus (20) Google Scholar Patient-report outcome and QOL measures should be compulsory components in these trials. Finally, they foreshadow a not-distant future in which PROs will enter routine clinical care. The salutary effects of using PRO measures to inform and guide clinical care have come into focus in recent years, and increasingly health systems are steering toward them. 2 Rotenstein LS Huckman RS Wagle NW Making patients and doctors happier – the potential of patient-reported outcomes. N Engl J Med. 2017; 377: 1309-1312 Crossref PubMed Scopus (151) Google Scholar