Patient-Reported Outcomes, Health-Related Quality of Life, and Clinical Outcomes for Urothelial Cancer Patients Receiving Chemo- or Immunotherapy: A Real-Life Experience

Abstract

Patients with urothelial cell carcinoma (UCC) often have comorbidities, which cause trouble for the completion of oncological treatment, and little is known about their quality of life (QoL). The aim of the present study was to obtain and describe patient-reported outcomes (PRO) and QoL data from UCC patients in the treatment for locally advanced muscle-invasive or metastatic UCC. A total of 79 patients with UCC completed four questionnaires (EORTC QLQ-C30, QLQ-BLM30, HADS, and select PRO-CTCAE™ questions) once weekly during their treatment. From those, 26 patients (33%) underwent neoadjuvant treatment for local disease while 53 patients (67%) were treated for metastatic disease. Of all patients, 54% did not complete the planned treatment due to progression, nephrotoxicity, death, or intolerable symptoms during treatment. The five most prevalent PRO-CTCAE grade ≥ 2 symptoms were frequent urination (37%), fatigue (35%), pain (31%), dry mouth (23%), and swelling of the arms or legs (23%). The baseline mean overall QoL was 61 (±SD 24) for all patients (neoadjuvant (73, ±SD 19) and metastatic (54, ±SD 24)) and remained stable over the course of treatment for both groups. A stable overall QoL was observed for the patients in this study. More than half of the patients did not, however, complete the planned treatment. Further supportive care is warranted for bladder cancer patients.

Prospective Evaluation of Health-Related Quality of Life in Patients with Metastatic Urothelial Carcinoma Undergoing Immunotherapy with Pembrolizumab: Symptom Burden Can Predict Survival

“…However, if metastatic disease is in progression, symptoms might increase and medical symptom control might get more sophisticated. This might be one reason that high symptom burden is significantly associated with lower overall Urol Int 2023;107:80-86 DOI: 10.1159/000526962 survival, but still further evaluation of HRQoL aspects as prognostic factor in bladder cancer and investigation of palliative care interventions in metastatic patients is absolutely essential [15,17].…”

“…But, as we discussed above, HRQoL issues are often not addressed in clinical practice [ 14 ], despite the fact that they are important, especially symptom burden and symptom control. Taarnhoj et al [ 17 ] described that the most bothersome symptoms for bladder cancer patients are urination, fatigue, and pain. In our opinion, these symptoms can be easily addressed in clinical practice.…”

“…Furthermore, symptom control is very important for palliative care and it is reported that good symptom control and early integration of palliative care into treatment can not only improve HRQoL but also can improve survival with a better quality of life [ 18 ]. The very simple conclusion of the study by Taarnhoj et al [ 17 ] was that further supportive care is warranted for bladder cancer patients. Consequently, physicians need to ask about HRQoL and symptoms during therapy of these patients and must treat to improve patient care.…”

Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study

“…Although the PRO-CTCAE has preliminarily demonstrated promise in several areas [ 12 - 17 ], with the broad electronic delivery of the PRO-CTCAE showing clinical utility [ 18 - 21 ], this tool has not yet enjoyed widespread use in the radiation oncology setting [ 22 - 24 ]. The exposure of surrounding healthy tissue to the radiation field is largely unavoidable for patients with cancer who are treated with radiation therapy, making patient reports of symptomatic toxicities particularly important for this population.…”

Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study (Preprint)

“…Version 1.0 of the PRO-CTCAE item library can be administered electronically [11] and includes 124 individual items representing the 78 toxicities, with multiple attributes captured for a given toxicity attribute question (eg, frequency, severity, and interference with usual or daily activities), as shown in Figure 1. Although the PRO-CTCAE has preliminarily demonstrated promise in several areas [12][13][14][15][16][17], with the broad electronic delivery of the PRO-CTCAE showing clinical utility [18][19][20][21], this tool has not yet enjoyed widespread use in the radiation oncology setting [22][23][24]. The exposure of surrounding healthy tissue to the radiation field is largely unavoidable for patients with cancer who are treated with radiation therapy, making patient reports of symptomatic toxicities particularly important for this population.…”