Patient reported symptoms associated with quality of life during chemo‐ or immunotherapy for bladder cancer patients with advanced disease

Abstract

Background: Bladder cancer (BC) patients with advanced disease have poor outcomes. The use of patient-reported outcomes (PROs) could lead to improvements in symptom management and hence quality of life (QoL). The aim of this study is to report correlations between selected PROs and QoL and thus to present symptoms that influence QoL. Identification of these symptoms during treatment can lead to earlier symptom management and thus secure improvements in QoL. Methods: BC patients in chemo-or immunotherapy for locally advanced or metastatic disease reported weekly PROs for the duration of their treatment. The PROs included EORTC QLQ-C30 and QLQ-BLM30 and 45 selected PRO-CTCAE items. Spearman's correlation analysis was performed for all PRO-CTCAE items and QLQ-C30 global QoL and subdomains. Results: In this study, 78 BC patients reported 724 questionnaires. Spearman's analysis showed significant correlations between almost all PRO-CTCAE items and the expected domain of QoL. The PRO-CTCAE items with the strongest correlations with QoL were anxiety (F, frequency item) and emotional function (r s = −0.603, P < .0001), concentration (S, severity item) and cognitive function (r s = −0.704, P < .0001), discouraged (F) and emotional function (r s = −0.659, P < .0001), fatigue (S) and role function (r s = −0.659, P < .0001) and sad (F) and emotional function (r s = −0.711, P < .0001). The weakest correlations were found for the PRO-CTCAE items urinary frequency, incontinence and urge, all with variations in the direction and significance of the correlations. Conclusions: This study delivers information on which PROs may influence QoL for patients in clinical trials or daily clinic. Psychological issues have a strong impact on QoL and should be dealt with during treatment to secure the best possible QoL for BC patients. K E Y W O R D S chemotherapy, immunotherapy, Patient-reported outcomes, quality of life, urinary bladder neoplasms

Health-related quality of life in cancer immunotherapy: a systematic perspective, using causal loop diagrams

“…Despite the importance of HRQoL of patients following immunotherapy, it has only received some limited, recent research attention [ 21 , 22 ]. One noticeable gap is that less HRQoL-focused research has been performed regarding cancer immunotherapy purely due to the treatment’s relative novelty.…”

Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: Study Protocol for a Randomized Controlled Trial

“…In cancer patients, it is common for psychological symptoms associated with the course of the disease to appear, such as anxiety, depression, insomnia, fatigue, and a poorer quality of life ( Mock et al, 2000 ; Satin et al, 2009 ; Corbett et al, 2016 ; Kuhnt et al, 2016 ; Zhou et al, 2017 ; Pitman et al, 2018 ; De Mol et al, 2020 ; Erim et al, 2020 ; Park et al, 2020 ; Taarnhøj et al, 2020 ; Yun et al, 2021 ). Among the different interventions developed to reduce these symptoms in cancer patients, acceptance and commitment therapy performs better than other interventions (such as cognitive-behavioral therapy) as it focuses on improving the psychological flexibility of patients, which causes improvements in associated symptoms, such as those mentioned above ( Feros et al, 2013 ; Arch and Mitchell, 2016 ; Aguirre-Camacho and Moreno-Jiménez, 2017 ; Bas and Dirik, 2019 ; González-Fernández and Fernández-Rodríguez, 2019 ).…”

“…In cancer patients, it is common to observe certain impairments as a consequence of the disease and its treatments. The most frequent psychological symptoms are anxiety (10–18%) and depression (11–20%), which, in addition, are consistently related to a worse quality of life in this group of patients ( Satin et al, 2009 ; Kuhnt et al, 2016 ; Pitman et al, 2018 ; De Mol et al, 2020 ; Erim et al, 2020 ; Park et al, 2020 ; Taarnhøj et al, 2020 ). Fatigue, understood as a subjective state of emotional and physical fatigue that interferes with the patient’s normal functioning, appears in up to 60% of cancer patients, while sleep disturbances, both in the form of insomnia, as in terms of difficulties when falling asleep, and maintaining sleep, is also observed in a high number of patients, in a range between 18 and 68% ( Mock et al, 2000 ; Corbett et al, 2016 ; Zhou et al, 2017 ; Yun et al, 2021 ).…”

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of urothelial cancer

“…In a study of bladder cancer patients, the PRO-CTCAE showed significant correlation with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, especially for psychological measures. 134 Despite BCG's long-standing historical efficacy for patients with NMIBC, its administration may negatively affect QOL by causing discomfort and functional impairment. While the majority of patients complete the 6-cycle induction course, a substantial number of patients discontinue maintenance due to symptoms negatively affecting their QOL.…”