Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions

Abstract

BACKGROUND: A broad, comprehensive review of studies exploring associations between lifestyle factors and non-muscle invasive bladder cancer (NMIBC) outcomes is warranted to consolidate recommendations and identify gaps in research. OBJECTIVE: To summarize the literature on associations between lifestyle factors and clinical outcomes among patients with NMIBC. METHODS: PubMed was systematically queried for articles published through March 2019 regarding lifestyle factors and recurrence, progression, cancer-specific mortality, and all-cause mortality among patients with NMIBC. RESULTS: Notwithstanding many ambiguities, there is good-quality evidence suggesting a benefit of smoking avoidance/cessation, healthy body mass index (BMI), and type II diabetes mellitus prevention and treatment. Lactobacillus casei probiotic supplementation may reduce recurrence. There have been individual studies suggesting a benefit for uncooked broccoli and supplemental vitamin E as well as avoidance of supplemental vitamin B9, areca nut chewing, and a "Western diet" pattern high in fried foods and red meat. Additional studies do not suggest associations between NMIBC outcomes and use of fibrin clot inhibitors; insulin and other oral hypoglycemics; statins; supplemental selenium, vitamin A, vitamin C, and vitamin B6; fluid intake and intake of specific beverages (e.g., alcohol, coffee, green tea, cola); various dietary patterns (e.g., Tex-Mex, high fruit and vegetable, low-fat); and occupational and chemical exposures. CONCLUSIONS: Despite a myriad of publications on lifestyle factors and NMIBC, a need remains for research on unexplored associations (e.g., physical activity) and further studies that can elucidate causal effects. This would inform future implementation strategies for healthy lifestyle change in NMIBC patients.

American Cancer Society nutrition and physical activity guideline for cancer survivors

“…The summary of evidence supported that overweight or obesity (BMI ≥25 kg/m 2 ) is associated with an increased risk of both disease recurrence and progression for patients with nonmuscle-invasive bladder cancer. 68 Inconclusive results were noted with BMI and cancer site-specific mortality and all-cause mortality. Two cohort studies suggested that measurement of adiposity and muscle mass by computerized tomography (CT) scans, versus anthropometry, serve as better predictors of clinical outcomes in patients who undergo cystectomy because these measurements capture both fat and skeletal muscle mass.…”

“…Indeed, sarcopenia was associated with an increased risk of all-cause mortality (HR, 1.67; 95% CI, 1.11-2.50), whereas BMI alone showed no association. 68 As acknowledged by the authors, the use of a single database (PubMed; and references of publications identified) was a limitation of their systematic review. Kidney cancer.…”

Association between blood pressure and BMI with bladder cancer risk and mortality in 340,000 men in three Swedish cohorts

“…In relation to BC‐specific mortality, studies on the association with BMI and BP, respectively, have shown inconsistent results and are few 9,10 . Most of these studies were conducted among patients undergoing radical cystectomy, 11‐18 and fewer studies were conducted at population level 19,20 .…”

Bladder cancer and exeRcise trAining during intraVesical thErapy—the BRAVE trial: a study protocol for a prospective, single-centre, phase II randomised controlled trial

“…Exercise is recommended to many patients with cancer in different clinical settings, however, there are no studies examining the effects of exercise in patients with NMIBC receiving intravesical therapy. 44 The patient with NMIBC group is older and has significant comorbidities that may make exercise more unsafe or less feasible compared with other patient with cancer groups. Moreover, no study to date has examined exercise during intravesical therapy.…”