Abstract
Purpose of Review
Bladder cancer (BC) is the second most common genitourinary malignancy, with a growing population of survivors globally. Over the past two decades, there has been a growing awareness of not only the oncologic, but also the quality of life ramifications of a BC diagnosis, treatment, and surveillance. In the current review, the literature surrounding the many domains that encompass bladder cancer survivorship is summarized and analyzed.
Recent Findings
There have been ongoing efforts to decrease perioperative morbidity, particularly in patients undergoing radical cystectomy, with mixed results. There is a growing emphasis on the short and long-term health-related quality of life (HR-QoL) impacts of bladder cancer spanning the domains of physical and mental QoL related to urinary function, sexual function, and financial and psychological burden, with validated measures specific to BC patients. There continue to be disparities in oncologic outcomes by race and gender. The impact of BC is prolonged and there is an unmet need for long term support and survivorship resources to address this.
Summary
There is a growing global population of bladder cancer patients, and their needs are complex and vary by stage, treatment, and certain demographic features. Outcome-centered perioperative strategies show potential to diminish treatment morbidity, and validated BC specific HR-QoL tools have helped to define the impact and burden of BC, but there continue to be large areas of unmet need that warrant greater study and intervention.
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References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
•• Hollenbeck BK, et al. Racial differences in treatment and outcomes among patients with early stage bladder cancer. Cancer. 2010;116:50–6. https://doi.org/10.1002/cncr.24701 Population-based analysis of disparities in outcomes by race, even in early stage BC.
Hollenbeck BK, Wei Y, Birkmeyer JD. Volume, process of care, and operative mortality for cystectomy for bladder cancer. Urology. 2007;69:871–5. https://doi.org/10.1016/j.urology.2007.01.040.
Casey MF, Gross T, Wisnivesky J, Stensland KD, Oh WK, Galsky MD. The impact of regionalization of cystectomy on racial disparities in bladder cancer care. J Urol. 2015;194:36–41. https://doi.org/10.1016/j.juro.2015.01.076.
Smaldone MC, Simhan J, Kutikov A, Canter DJ, Starkey R, Zhu F, et al. Trends in regionalization of radical cystectomy in three large northeastern states from 1996 to 2009. Urol Oncol. 2013;31:1663–9. https://doi.org/10.1016/j.urolonc.2012.04.018.
Barocas DA, Alvarez JA, Koyama T, Anderson CB, Gray DT, Fowke JH, et al. Racial variation in the quality of surgical care for bladder cancer. Cancer. 2014;120:1018–25. https://doi.org/10.1002/cncr.28520.
Schinkel JK, Shao S, Zahm SH, McGlynn KA, Shriver CD, Zhu K. Overall and recurrence-free survival among black and white bladder cancer patients in an equal-access health system. Cancer Epidemiol. 2016;42:154–8. https://doi.org/10.1016/j.canep.2016.04.012.
Kaye DR, Canner JK, Kates M, Schoenberg MP, Bivalacqua TJ. Do African American patients treated with radical cystectomy for bladder cancer have worse overall survival? Accounting for pathologic staging and patient demographics beyond race makes a difference. Bladder Cancer. 2016;2:225–34. https://doi.org/10.3233/BLC-150041.
•• Uhlig A, et al. Gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer: a systematic review and meta-analysis. J Urol. 2018;200:48–60. https://doi.org/10.1016/j.juro.2017.11.150 A recent summary of the data regarding female gender and disparities in BC outcomes.
Liu S, Yang T, Na R, Hu M, Zhang L, Fu Y, et al. The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27,912 patients. Int Urol Nephrol. 2015;47:951–8. https://doi.org/10.1007/s11255-015-0980-6.
Garg T, Pinheiro LC, Atoria CL, Donat SM, Weissman JS, Herr HW, et al. Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis. J Urol. 2014;192:1072–7. https://doi.org/10.1016/j.juro.2014.04.101.
Cohn JA, Vekhter B, Lyttle C, Steinberg GD, Large MC. Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims-based investigation. Cancer. 2014;120:555–61. https://doi.org/10.1002/cncr.28416.
Edmondson AJ, Birtwistle JC, Catto JWF, Twiddy M. The patients' experience of a bladder cancer diagnosis: a systematic review of the qualitative evidence. J Cancer Surviv. 2017;11:453–61. https://doi.org/10.1007/s11764-017-0603-6.
Fung C, Pandya C, Guancial E, Noyes K, Sahasrabudhe DM, Messing EM, et al. Impact of bladder cancer on health related quality of life in 1,476 older Americans: a cross-sectional study. J Urol. 2014;192:690–5. https://doi.org/10.1016/j.juro.2014.03.098.
•• Smith AB, et al. Impact of bladder cancer on health-related quality of life. BJU Int. 2018;121:549–57. https://doi.org/10.1111/bju.14047 Compared BC to non-BC controls and found significant HR-QoL decline globally, with persistence.
Siracusano S, Niero M, Lonardi C, Cerruto MA, Ciciliato S, Toffoli L, et al. Development of a questionnaire specifically for patients with ileal orthotopic neobladder (IONB). Health Qual Life Outcomes. 2014;12:135. https://doi.org/10.1186/s12955-014-0135-y.
Madersbacher S, Studer UE. Contemporary cystectomy and urinary diversion. World J Urol. 2002;20:151–7. https://doi.org/10.1007/s00345-002-0255-6.
Lin-Brande M. et al. Population based assessment of continent diversion utilization and preoperative morbidity in the United States. 2018.
Hart S, et al. Quality of life after radical cystectomy for bladder cancer in patients with an ileal conduit, cutaneous or urethral Kock pouch. J Urol. 1999;162:77–81.
Dutta SC, Chang SS, Coffey CS, Smith JA Jr, Jack G, Cookson MS. Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder. J Urol. 2002;168:164–7.
Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol. 2005;173:1318–22. https://doi.org/10.1097/01.ju.0000149080.82697.65.
•• Ghosh A, Somani BK. Recent trends in postcystectomy health-related quality of life (QoL) favors neobladder diversion: systematic review of the literature. Urology. 2016;93:22–6. https://doi.org/10.1016/j.urology.2015.12.079 Recent systematic review showing that there is a QoL advantage to neobladder over other diversion types.
Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113:11–23. https://doi.org/10.1111/bju.12121.
Simon J, et al. Neobladder emptying failure in males: incidence, etiology and therapeutic options. J Urol. 2006;176:1468–72; discussion 1472. https://doi.org/10.1016/j.juro.2006.06.048.
Zlatev DV, Skinner EC. Orthotopic urinary diversion for women. Urol Clin North Am. 2018;45:49–54. https://doi.org/10.1016/j.ucl.2017.09.005.
•• Pederzoli F, Campbell JD, Matsui H, Sopko NA, Bivalacqua TJ. Surgical factors associated with male and female sexual dysfunction after radical cystectomy: what do we know and how can we improve outcomes? Sex Med Rev. 2018;6:469–81. https://doi.org/10.1016/j.sxmr.2017.11.003 A comprehensive review of the sexual dysfunction and its etiologies after RC.
Hernández V, et al. Oncological and functional outcomes of sexual function-preserving cystectomy compared with standard radical cystectomy in men: a systematic review. Urol Oncol. 2017;35:539.e517–29. https://doi.org/10.1016/j.urolonc.2017.04.013.
Hautmann RE, Stein JP. Neobladder with prostatic capsule and seminal-sparing cystectomy for bladder cancer: a step in the wrong direction. Urol Clin North Am. 2005;32:177–85. https://doi.org/10.1016/j.ucl.2005.02.001.
Choi JM, Nelson CJ, Stasi J, Mulhall JP. Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors. J Urol. 2007;177:2223–6. https://doi.org/10.1016/j.juro.2007.01.150.
Haney NM, Alzweri LM, Hellstrom WJG. Male orgasmic dysfunction post-radical pelvic surgery. Sex Med Rev. 2018;6:429–37. https://doi.org/10.1016/j.sxmr.2017.12.003.
Kessler TM, Burkhard FC, Studer UE. Clinical indications and outcomes with nerve-sparing cystectomy in patients with bladder cancer. Urol Clin North Am. 2005;32:165–75. https://doi.org/10.1016/j.ucl.2005.02.005.
Booth BB, Rasmussen A, Jensen JB. Evaluating sexual function in women after radical cystectomy as treatment for bladder cancer. Scand J Urol. 2015;49:463–7. https://doi.org/10.3109/21681805.2015.1055589.
Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B. Female sexual dysfunction post radical cystectomy and urinary diversion. Climacteric. 2016;19:546–50. https://doi.org/10.1080/13697137.2016.1225714.
Veskimäe E, Neuzillet Y, Rouanne M, MacLennan S, Lam TBL, Yuan Y, et al. Systematic review of the oncological and functional outcomes of pelvic organ-preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU Int. 2017;120:12–24. https://doi.org/10.1111/bju.13819.
Kowalkowski MA, Chandrashekar A, Amiel GE, Lerner SP, Wittmann DA, Latini DM, et al. Examining sexual dysfunction in non-muscle-invasive bladder cancer: results of cross-sectional mixed-methods research. Sex Med. 2014;2:141–51. https://doi.org/10.1002/sm2.24.
Narang AK, Nicholas LH. Out-of-pocket spending and financial burden among Medicare beneficiaries with cancer. JAMA Oncol. 2017;3:757–65. https://doi.org/10.1001/jamaoncol.2016.4865.
Avritscher EB, et al. Clinical model of lifetime cost of treating bladder cancer and associated complications. Urology. 2006;68:549–53. https://doi.org/10.1016/j.urology.2006.03.062.
Gore JL, Gilbert SM. Improving bladder cancer patient care: a pharmacoeconomic perspective. Expert Rev Anticancer Ther. 2013;13:661–8. https://doi.org/10.1586/era.13.58.
Casilla-Lennon MM, Choi SK, Deal AM, Bensen JT, Narang G, Filippou P, et al. Financial toxicity among patients with bladder cancer: reasons for delay in care and effect on quality of life. J Urol. 2018;199:1166–73. https://doi.org/10.1016/j.juro.2017.10.049.
Yabroff KR, Davis WW, Lamont EB, Fahey A, Topor M, Brown ML, et al. Patient time costs associated with cancer care. J Natl Cancer Inst. 2007;99:14–23. https://doi.org/10.1093/jnci/djk001.
Yabroff KR, Bradley CJ, Mariotto AB, Brown ML, Feuer EJ. Estimates and projections of value of life lost from cancer deaths in the United States. J Natl Cancer Inst. 2008;100:1755–62. https://doi.org/10.1093/jnci/djn383.
•• Svatek RS, et al. The economics of bladder cancer: costs and considerations of caring for this disease. Eur Urol. 2014;66:253–62. https://doi.org/10.1016/j.eururo.2014.01.006 A comprehensive review of the literature related to cost and BC care, as well as strategies for addressing these.
Chamie K, Saigal CS, Lai J, Hanley JM, Setodji CM, Konety BR, et al. Compliance with guidelines for patients with bladder cancer: variation in the delivery of care. Cancer. 2011;117:5392–401. https://doi.org/10.1002/cncr.26198.
Hollingsworth JM, Zhang Y, Krein SL, Ye Z, Hollenbeck BK. Understanding the variation in treatment intensity among patients with early stage bladder cancer. Cancer. 2010;116:3587–94. https://doi.org/10.1002/cncr.25221.
Madeb R, Golijanin D, Noyes K, Fisher S, Stephenson JJ, Long SR, et al. Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors. Cancer. 2009;115:2660–70. https://doi.org/10.1002/cncr.24311.
Messing EM, Tangen CM, Lerner SP, Sahasrabudhe DM, Koppie TM, Wood DP Jr, et al. Effect of Intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non-muscle-invasive bladder cancer on tumor recurrence: SWOG S0337 randomized clinical trial. JAMA. 2018;319:1880–8. https://doi.org/10.1001/jama.2018.4657.
Lee CT, Barocas D, Globe DR, Oefelein MG, Colayco DC, Bruno A, et al. Economic and humanistic consequences of preventable bladder tumor recurrences in nonmuscle invasive bladder cancer cases. J Urol. 2012;188:2114–9. https://doi.org/10.1016/j.juro.2012.08.005.
Wolff EM, Chihara Y, Pan F, Weisenberger DJ, Siegmund KD, Sugano K, et al. Unique DNA methylation patterns distinguish noninvasive and invasive urothelial cancers and establish an epigenetic field defect in premalignant tissue. Cancer Res. 2010;70:8169–78. https://doi.org/10.1158/0008-5472.CAN-10-1335.
Santoni G, Morelli MB, Amantini C, Battelli N. Urinary markers in bladder cancer: an update. Front Oncol. 2018;8:362. https://doi.org/10.3389/fonc.2018.00362.
Wadhwa N, Jatawa SK, Tiwari A. Non-invasive urine based tests for the detection of bladder cancer. J Clin Pathol. 2012;65:970–5. https://doi.org/10.1136/jclinpath-2012-200812.
Klaassen Z, Li K, Kassouf W, Black PC, Dragomir A, Kulkarni GS. Contemporary cost-consequence analysis of blue light cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer. Can Urol Assoc J. 2017;11:173–81. https://doi.org/10.5489/cuaj.4568.
Geavlete B, Multescu R, Georgescu D, Jecu M, Stanescu F, Geavlete P. Treatment changes and long-term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non-muscle-invasive bladder cancer (NMIBC)? BJU Int. 2012;109:549–56. https://doi.org/10.1111/j.1464-410X.2011.10374.x.
Daneshmand S, Patel S, Lotan Y, Pohar K, Trabulsi E, Woods M, et al. Efficacy and safety of blue light flexible cystoscopy with hexaminolevulinate in the surveillance of bladder cancer: a phase III, comparative, Multicenter Study. J Urol. 2018;199:1158–65. https://doi.org/10.1016/j.juro.2017.11.096.
Skolarus TA, Ye Z, Zhang S, Hollenbeck BK. Regional differences in early stage bladder cancer care and outcomes. Urology. 2010;76:391–6. https://doi.org/10.1016/j.urology.2009.12.079.
Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–50. https://doi.org/10.1016/j.eururo.2014.11.043.
Djaladat H, Katebian B, Bazargani ST, Miranda G, Cai J, Schuckman AK, et al. 90-day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study. World J Urol. 2017;35:907–11. https://doi.org/10.1007/s00345-016-1950-z.
Kim SP, Boorjian SA, Shah ND, Karnes RJ, Weight CJ, Moriarty JP, et al. Contemporary trends of in-hospital complications and mortality for radical cystectomy. BJU Int. 2012;110:1163–8. https://doi.org/10.1111/j.1464-410X.2012.10990.x.
Zainfeld D, Djaladat H. Enhanced recovery after urologic surgery-current applications and future directions. J Surg Oncol. 2017;116:630–7. https://doi.org/10.1002/jso.24821.
Tyson MD, Chang SS. Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes. Eur Urol. 2016;70:995–1003. https://doi.org/10.1016/j.eururo.2016.05.031.
Kukreja JB, Metcalfe MJ, Qiao W, Kamat AM, Dinney CPN, Navai N. Cost-effectiveness of robot-assisted radical cystectomy using a propensity-matched cohort. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.07.001.
Dobbs RW, et al. Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense? Minerva Urol Nefrol. 2017;69:313–23. https://doi.org/10.23736/S0393-2249.16.02866-6.
Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Malek R, Kübler H, et al. A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol. 2018;36:43–53. https://doi.org/10.1016/j.urolonc.2017.10.002.
Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, et al. Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic. J Clin Oncol. 2017;35:2299–305. https://doi.org/10.1200/JCO.2016.69.2327.
Chen RC, Shipley WU, Efstathiou JA, Zietman AL. Trimodality bladder preservation therapy for muscle-invasive bladder cancer. J Natl Compr Cancer Netw. 2013;11:952–60.
Schrag D, Mitra N, Xu F, Rabbani F, Bach PB, Herr H, et al. Cystectomy for muscle-invasive bladder cancer: patterns and outcomes of care in the Medicare population. Urology. 2005;65:1118–25. https://doi.org/10.1016/j.urology.2004.12.029.
Gray PJ, Fedewa SA, Shipley WU, Efstathiou JA, Lin CC, Zietman AL, et al. Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol. 2013;63:823–9. https://doi.org/10.1016/j.eururo.2012.11.015.
Williams SB, Shan Y, Jazzar U, Mehta HB, Baillargeon JG, Huo J, et al. Comparing survival outcomes and costs associated with radical cystectomy and trimodal therapy for older adults with muscle-invasive bladder cancer. JAMA Surg. 2018. https://doi.org/10.1001/jamasurg.2018.1680.
Palapattu GS, et al. Assessment of perioperative psychological distress in patients undergoing radical cystectomy for bladder cancer. J Urol. 2004;172:1814–7.
Klaassen Z, et al. The impact of radical cystectomy and urinary diversion on suicidal death in patients with bladder cancer. J Wound Ostomy Continence Nurs. 2016;43:152–7. https://doi.org/10.1097/WON.0000000000000188.
Klaassen Z, et al. Changing trends for suicidal death in patients with bladder cancer: a 40+ year population-level analysis. Clin Genitourin Cancer. 2018;16:206–212.e201. https://doi.org/10.1016/j.clgc.2017.12.016.
Afshar M, Bardoli AD, Tanner JR, Macfarlane N, Pickering L, Anderson C, et al. Patients with urological malignancy are 5 times more likely to commit suicide: a large national cohort study. Eur Urol Suppl. 2018;17:e100. https://doi.org/10.1016/S1569-9056(18)30920-5.
•• Mohamed NE, et al. Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices. Urol Oncol. 2016;34:531.e537–14. https://doi.org/10.1016/j.urolonc.2016.06.010 Mixed-methods study of the unmet needs of patients after RC.
Mohamed NE, Chaoprang Herrera P, Hudson S, Revenson TA, Lee CT, Quale DZ, et al. Muscle invasive bladder cancer: examining survivor burden and unmet needs. J Urol. 2014;191:48–53. https://doi.org/10.1016/j.juro.2013.07.062.
Kvale EA, Huang CHS, Meneses KM, Demark-Wahnefried W, Bae S, Azuero CB, et al. Patient-centered support in the survivorship care transition: outcomes from the patient-owned survivorship care plan intervention. Cancer. 2016;122:3232–42. https://doi.org/10.1002/cncr.30136.
•• McCanney J, et al. Addressing survivorship in cancer care. J Natl Compr Canc Netw. 2018;16:801–6. https://doi.org/10.6004/jnccn.2018.7054 A report from the NCCN identifiying gaps and unmet needs in regard to cancer survivors.
Lee CT, Mei M, Ashley J, Breslow G, O'Donnell M, Gilbert S, et al. Patient resources available to bladder cancer patients: a pilot study of healthcare providers. Urology. 2012;79:172–7. https://doi.org/10.1016/j.urology.2011.07.1405.
Paterson C, Jensen BT, Jensen JB, Nabi G. Unmet informational and supportive care needs of patients with muscle invasive bladder cancer: a systematic review of the evidence. Eur J Oncol Nurs. 2018;35:92–101. https://doi.org/10.1016/j.ejon.2018.05.006.
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Sumeet K. Bhanvadia declares no potential conflicts of interest.
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Bhanvadia, S.K. Bladder Cancer Survivorship. Curr Urol Rep 19, 111 (2018). https://doi.org/10.1007/s11934-018-0860-6
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DOI: https://doi.org/10.1007/s11934-018-0860-6