Impact of Effective Intravesical Therapies on Quality of Life in Patients with Non-Muscle Invasive Bladder Cancer: A Systematic Review

Abstract

Background: Conventional and newly emerged intravesical modalities have demonstrated prophylactic effectiveness that may improve quality of life (QoL) in non-muscle invasive bladder cancer. The purpose of this study is to analyze existing QoL evidence in patients receiving any form of intravesical therapy. Methods: A PubMed search without time restriction was conducted to identify all relevant studies in accordance with the PICOT question. Additionally, a search was also performed in the Cochrane library database, Internet, and citation. The CONSORT 2010 checklist and STROBE statement checklist were used to evaluate the risk of bias of the included studies. Results: A total of 24 eligible articles were included, which consisted of 11 interventional and 13 observational studies. Intravesical therapy with Bacillus Calmette–Guérin (BCG) or certain chemotherapeutic agents worsens symptom burdens and functional performance during the initial induction phase while continuous improved is observed throughout the maintenance treatment and beyond. Hyperthermia has shown a positive trend in enhancing QoL of patients receiving intravesical chemotherapy, which requires more investigations. However, QoL data were unavailable for other forms of immunotherapy, immune checkpoint inhibitors, electromotive drug administration, and photodynamic therapy. Conclusions: Limited studies suggested the long-term positive impact of intravesical BCG immunotherapy and chemotherapy. However, existing evidence was lacking to clarify the impact of many emerging intravesical therapies that have suggested to be effective and safe, which demands treatment-specific QoL studies.

Quality of Life in the Phase 2/3 Trial of N-803 Plus Bacillus Calmette-Guérin in Bacillus Calmette-Guérin‒Unresponsive Nonmuscle-Invasive Bladder Cancer

“…The finding of relative stability of GH and PF during the course of the study is similar to that reported by Catto et al 23 and described by others 24,25 for BCG monotherapy, suggesting combination N-803 plus BCG intravesical therapy is at least as tolerable as treatment with BCG alone.…”

Association Between Residual Urine Volume and Recurrence Among Patients at High Risk of Non-Muscle-Invasive Bladder Carcinoma With Versus Without Bacillus Calmette-Guérin Treatment

“…The urinary status of patients with NMIBC has important implications for maintaining quality of life through stable urination and the administration of appropriate BCG treatment [10,21,22]. The quality of life of patients with non-muscle-invasive BC shows significant improvement in the fourth week after BCG induction [23].…”

BCG induced lower urinary tract symptoms during treatment for NMIBC—Mechanisms and management strategies

“…BCG immunotherapy is the most successful adjuvant therapy for reducing the rate of NMIBC recurrence and progression (Kamat et al, 2015 ; Jiang and Redelman-Sidi, 2022 ; Unsworth-White et al, 2022 ). However, approximately 70% of patients undergoing BCG immunotherapy will develop lower urinary tract side effects characterized by sensory dysfunction including urinary urgency, urinary frequency, dysuria, and bladder pain that significantly impact wellbeing during treatment (Alexandroff et al, 1999 ; Brausi et al, 2014 ; Nouhaud et al, 2017 ; Danielsson et al, 2018 ; Unsworth-White et al, 2022 ; Yuen et al, 2022 ). Moreover, ~7–20% of patients are forced to discontinue BCG therapy due to the severity of their lower urinary tract symptoms (LUTS), significantly increasing the risk of cancer progression and reducing survival (van der Meijden et al, 2003 ; Brausi et al, 2014 ; Krajewski et al, 2018 ; Lebacle et al, 2021 ).…”