Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review

Abstract

Purpose Diet, physical activity, and smoking cessation are modifiable lifestyle factors that have been shown to improve health-related quality of life (HRQOL) in many cancer survivors. Our objective was to systematically review the literature on the associations between lifestyle factors, namely diet, physical activity, smoking status, and HRQOL in bladder cancer survivors. Methods We queried PubMed, EMBASE, and Cochrane libraries. Two reviewers reviewed abstracts independently, and a third reviewer arbitrated disagreements. A descriptive analysis was performed. Quality assessment was conducted using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials. Results We identified 1167 publications in the initial search, of which 9 met inclusion criteria for full-text review. We were able to obtain data on the outcomes of interest for 5 publications. A total of 1288 patients who underwent treatment for bladder cancer were included. Three studies were observational by design and two were randomized controlled trials. Physical activity was addressed by 4 studies, smoking status by 2 studies, and diet by 1 study. Conclusions The review highlights the limited evidence around lifestyle factors and quality of life in bladder cancer survivors. There is some evidence for a positive association between HRQOL and physical activity, but insufficient evidence upon which to draw conclusions about the effects of consuming fruits and vegetables or non-smoking. Implications for Cancer Survivors There is limited evidence to support a positive association between health-related quality of life and physical activity, but insufficient evidence upon which to base any conclusions about consumption of fruits and vegetables or smoking cessation in bladder cancer survivors.

Physical activity patterns and associations with health-related quality of life in bladder cancer survivors

“…[18, 27] A recent systematic review on associations between lifestyle factors and HRQOL in bladder cancer survivors reinforced our results. [28] These findings are also consistent with those in multiple other cancers, including colon, prostate, ovarian, and endometrial cancers. [29–33] Mechanisms through which physical activity improves HRQOL may include improved aerobic fitness, increased strength, decreased anxiety and depression, and improved body image.…”

Modifiable lifestyle behaviours impact the health‐related quality of life of bladder cancer survivors

“…More than two‐thirds (77.3%) of study participants were sedentary or insufficiently active according to the American Cancer Society (ACS) guidelines . The present study cohort reported lower total PA levels than the general Canadian population, and also compared to other bladder cancer survivor studies . This may be due to our exclusion of mild exercise, which is not included in the ACS recommendations.…”

“…This may be due to our exclusion of mild exercise, which is not included in the ACS recommendations. Mild exercise can include domestic work, which was the PA domain that Gopalakrishna et al found most reported by bladder cancer survivors. PA was positively and strongly associated with HRQoL, a finding that is supported by previous studies of bladder cancer populations .…”

“…Mild exercise can include domestic work, which was the PA domain that Gopalakrishna et al found most reported by bladder cancer survivors. PA was positively and strongly associated with HRQoL, a finding that is supported by previous studies of bladder cancer populations . Given this, as well as previous work that has demonstrated that regular PA can result in a 50% reduction in risk of functional limitations and disability , supervised aerobic and resistance exercise programmes should be recommended to bladder cancer survivors who are not meeting PA recommendations.…”

“…However, to date, there have been few large studies that assess the degree to which bladder cancer survivors are adhering to current lifestyle recommendations across the disease trajectory, and between those with different stage of disease (muscle‐invasive bladder cancer [MIBC] vs non‐muscle‐invasive bladder cancer [NMIBC]). Further, the impact of lifestyle behaviours of bladder cancer survivors on HRQoL remains unclear due to small sample sizes and measurement issues including the use of generic HRQoL questionnaires or bladder cancer‐specific questionnaires that have not been validated .…”