title: Quality of Life in Long-term Survivors of Muscle-Invasive Bladder Cancer.
abstract: Health-related quality of life (QOL) has not been well-studied in survivors of muscle-invasive bladder cancer (MIBC). The present study compared long-term QOL in MIBC patients treated with radical cystectomy (RC) versus bladder-sparing trimodality therapy (TMT).
  
  
  
  This cross-sectional bi-institutional study identified 226 patients with nonmetastatic cT2-cT4 MIBC, diagnosed in 1990 to 2011, who were eligible for RC and were disease free for ≥2 years. Six validated QOL instruments were administered: EuroQOL EQ-5D, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire and EORTC MIBC module, Expanded Prostate Cancer Index Composite bowel scale, Cancer Treatment and Perception Scale, and Impact of Cancer, version 2. Multivariable analyses of the mean QOL scores were conducted using propensity score matching.
  
  
  
  The response rate was 77% (n=173). The median follow-up period was 5.6 years. Of the 173 patients, 64 received TMT and 109, RC. The median interval from diagnosis to questionnaire completion was 9 years after TMT and 7 years after RC (P=.009). No significant differences were found in age, gender, comorbidities, tobacco history, performance status, or tumor stage. On multivariable analysis, patients who received TMT had better general QOL by 9.7 points of 100 compared with those who had received RC (P=.001) and higher physical, role, social, emotional, and cognitive functioning by 6.6 to 9.9 points (P≤.04). TMT was associated with better bowel function by 4.5 points (P=.02) and fewer bowel symptoms by 2.7 to 7.1 points (P≤.05). The urinary symptom scores were similar. TMT was associated with better sexual function by 8.7 to 32.1 points (P≤.02) and body image by 14.8 points (P<.001). The patients who underwent TMT reported greater informed decision-making scores by 13.6 points (P=.01) and less concern about the negative effect of cancer by 6.8 points (P=.006). The study limitations included missing baseline QOL data and different follow-up times.
  
  
  
  Both TMT and RC result in good long-term QOL outcomes in MIBC survivors, supporting TMT as a good alternative to RC for selected patients. Whether TMT leads to superior QOL requires prospective validation.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts; Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Kimberley S
authors.initials: KS
authors.lastname: Mak
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alec
authors.initials: A
authors.lastname: Eidelman
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clayman
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jed-Sian
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Drumm
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Feldman
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: William U
authors.initials: WU
authors.lastname: Shipley
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: jefstathiou@partners.org.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003430:Cross-Sectional Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000379:methods*; D057216:Propensity Score; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D014555:Urination Disorders / Q000209:etiology