Impact of bladder cancer on health related quality of life in 1,476 older Americans: a cross-sectional study

Abstract

Purpose: The impact of bladder cancer diagnosis on health related quality of life is poorly understood. We compared health related quality of life measures in patients before and after bladder cancer diagnosis.

Materials and methods: We performed a cross-sectional study in 1,476 patients 65 years old or older with bladder cancer in the SEER-MHOS linkage database between 1998 and 2007 to assess differences in physical and mental component summary scores in 620 and 856 who completed a survey before and after bladder cancer diagnosis, respectively. To determine differences in physical and mental scores in the prediagnosis and post-diagnosis cohorts, we used ANOVA adjusting for baseline covariates.

Results: There were statistically significant differences in physical and mental component summary scores between the prediagnosis and post-diagnosis groups (-2.7, 95% CI -3.8, -1.7 vs -1.4, 95% CI -2.6, -0.3). In patients with nonmuscle invasive bladder cancer the physical and mental score differences were -1.9 (p <0.01) and -1.4 (p = 0.01), respectively. In those with muscle invasive bladder cancer there was a statistically and clinically significant difference in the physical but not the mental score (-5.3, p <0.01 vs -2.7, p = 0.07). This difference in the physical domain persisted up to 10 years after the diagnosis of muscle invasive bladder cancer. Patients with bladder cancer who had 4 or more comorbid medical conditions and 1 or more deficits in daily living activity were most at risk for low physical component summary scores.

Conclusions: Future research into interventions to improve health related quality of life and methods to incorporate health related quality of life into decision making models are critical to improve outcomes in older patients with bladder cancer.

Keywords: aged; quality improvement; quality of life; questionnaires; urinary bladder neoplasms.

Figure 1

Study design. Study included patients with BC who completed SF-36 or VR-12 more than 1 year before and/or any time after diagnosis. To accurately capture diagnosis effects on HRQOL we excluded patients who completed baseline SF-36 or VR-12 within 1 year of diagnosis in comparator group. Of surveys completed by 179 patients before and after diagnosis only those completed after diagnosis were included to ensure independence of error terms on regression analysis. Of surveys completed by patients who completed more than 1 after diagnosis only those completed closest to diagnosis were included. Covariates included race, gender, age at diagnosis, marital status, education, household income, smoking, comorbidity score and ADL.

Figure 2

Cross-sectional analysis of PCS (blue bars) and MCS (red bars) HRQOL scores of all 1,476 patients with BC by time since diagnosis adjusted for baseline covariates, including cancer stage, race, gender, age at diagnosis, marital status, education, household income, smoking, comorbidity score and ADL. Total scores were normalized to general American population on scale of 0 to 100 (mean ± SD 50 ± 10). Asterisk indicates PCS and MCS at each time after diagnosis vs those greater than 1 year before diagnosis (ANOVA p ≤ 0.05).

Figure 3

Cross-sectional analysis of PCS (blue bars) and MCS (red bars) HRQOL scores of 1,234 patients with NMIBC by time since diagnosis unadjusted for baseline covariates. Total scores were normalized to general American population on scale of 0 to 100 (mean ± SD 50 ± 10). Asterisk indicates PCS and MCS at each time after diagnosis vs those greater than 1 year before diagnosis (bivariate p ≤ 0.05).

Figure 4

Cross-sectional analysis of PCS (blue bars) and MCS (red bars) HRQOL scores of 242 patients with MIBC by time since diagnosis unadjusted for baseline covariates. Total scores were normalized to general American population on scale of 0 to 100 (mean ± SD 50 ± 10). No comparison was made after 10 years due to only 1 MIBC case. Asterisk indicates PCS and MCS at each time after diagnosis vs those greater than 1 year before diagnosis (bivariate p ≤ 0.05).