Health related quality of life assessments for patients with bladder cancer

We review the current data regarding the impact of various therapeutic alternatives for bladder cancer on health related (HR) quality of life (QOL).

A MEDLINE search of the English literature from 1966 to November 2003 using the search terms "cystectomy," "intravesical therapy" or "bladder cancer" and quality of life yielded 33 articles. Studies of metastatic disease were excluded. The method of evaluation of quality of life in each article was assessed, particularly the instruments used and the population studied.

The majority of these reports (20 of 33) compared the impact of different types of urinary diversion on quality of life. The reports provided conflicting data, with several studies showing no significant difference in overall QOL. Some studies revealed a greater improvement in HRQOL with time following continent diversion. Only 2 reports discussed evaluation of HRQOL during intravesical therapy. Either an established standardized QOL instrument or an internally validated instrument was used in all but 8 of the studies. No reports compared the HRQOL effects of bladder sparing treatments to radical cystectomy.

There is no single measure of HRQOL predominantly used in patients with bladder cancer. There is a lack of data comparing HRQOL outcomes in patients receiving bladder sparing therapies versus cystectomy. Development of a universally applicable validated instrument would allow a more effective comparison of HRQOL outcomes in these patients as well as in those with superficial and muscle invasive bladder cancer.