Differences in Quality of Life Between Men and Women who Undergo Bladder Preservation with Trimodality Therapy

Sex-specific differences exist in muscle invasive bladder cancer (MIBC): men have a higher incidence; women present with more advanced disease; and surgical options differ between men and women. Health related quality of life (HRQoL) for male versus female patients with MIBC is not well understood and limited data exists in patients who undergo bladder preservation with trimodality therapy (TMT). The purpose of this study was to compare long-term HRQoL between men and women who have undergone TMT.

This was a secondary analysis of a prior study that reported long-term HRQoL differences for patients who underwent TMT. We analyzed patient reported HRQoL data to assess differences in HRQoL between men and women.

Of the 64/74 (86%) TMT patients that completed questionnaires, 14 (22%) were women. Median age at diagnosis was 60 years for women and 66 years for men (p = 0.007). From six HRQoL instruments, there were two responses with a statistically significant difference between women and men -incidence of diarrhea and degree of sexual activity. Fifty percent of women compared to 86%of men reported no diarrhea (p = 0.02). A greater percentage of women reported some degree of sexual activity in the 4 weeks prior to questionnaire completion (p = 0.04), and sexual interest following TMT declined significantly with age in men, but not in women.

In general, men and women report very good long-term HRQoL following TMT. There were, however, some differences between the sexes. Understanding this difference, especially related to sexual function, will allow more informed decision making by patients when choosing between treatment modalities.