Quality of life after therapy for muscle-invasive bladder cancer

Therapy for invasive bladder cancer should aim at cure, and besides radical organ-removing surgery, bladder-sparing alternatives are available. Here I report the current status on quality-of-life issues after therapy for invasive bladder cancer.

Consensus has not been reached on the definition of the concept 'quality of life', resulting in numerous ways of measuring it. It is reasonable to believe that the individually self-assessed level of quality of life is affected by the total post-therapeutic symptom burden, that is, the long-term side effects of a therapy are predictors for quality of life. The affection on quality of life by a symptom on an individual can never be predicted because of differences in symptom tolerance. On the group level, however, some symptoms are generally highly distressful, whereas others are generally low distressors. A new area of quality-of-life research is evolving, measuring symptoms, symptom distress and effects on quality of life.

Cystectomy followed by orthotopic bladder replacement seems to keep a high level of quality of life in select cases; however, ileal conduit is still an excellent option in other patients. Bladder-sparing alternatives are available. An individual pre-therapeutic consultation will aid in determining the radical therapeutic method in each individual patient.