Propensity-matched analysis of patient-reported outcomes for neoadjuvant chemotherapy prior to radical cystectomy
To evaluate patient-reported outcomes (PROs) for bladder cancer patients undergoing neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) using longitudinal data and propensity-matched scoring analyses.
155 patients with muscle-invasive bladder cancer scheduled for RC completed the European Organization for Research and Treatment of Cancer questionnaires, EORTC QLQ-C30, EORTC QLQ-BLM30, Fear of Recurrence Scale, Mental Health Inventory and Satisfaction with Life Scale within 4 weeks of surgery. A propensity-matched analysis was performed comparing pre-surgery PROs among 101 patients who completed NAC versus 54 patients who did not receive NAC. We also compared PROs pre- and post-chemotherapy for 16 patients who had data available for both time points.
In propensity-matched analysis, NAC-treated patients reported better emotional and sexual function, mental health, urinary function and fewer financial concerns compared to those that did not receive NAC. Longitudinal analysis showed increases in fatigue, nausea and appetite loss following chemotherapy.
Propensity-matched analysis did not demonstrate a negative effect of NAC on PRO. Several positive associations of NAC were found in the propensity-matched analysis, possibly due to other confounding differences between the two groups or actual clinical benefit. Longitudinal analysis of a small number of patients found small to modest detrimental effects from NAC similar to toxicities previously reported. Our preliminary findings, along with known survival and toxicity data, should be considered in decision-making for NAC.
KeywordsPatient-reported outcomes Patient-centered research Health-related quality of life Bladder cancer
MA Feuerstein: project development, data analysis, manuscript writing. L Goldstein: project development, data collection and management, data analysis, manuscript writing. B Reaves: project development, data collection and management, data analysis. A Sun: data collection and management. M Goltzman: project development, data collection and management. BA Morganstern: project development, data collection and management. A Shabsigh: protocol and project development. DF Bajorin: protocol and project development. JE Rosenberg: protocol and project development. SM Donat: protocol and project development. HW Herr: protocol and project development. VP Laudone: protocol and project development. TM Atkinson: data analysis, manuscript writing/editing. Y Li: protocol and project development, data analysis. G Dalbagni: protocol and project development. B Rapkin: protocol and project development, data management, data analysis, manuscript writing. BH Bochner: protocol and project development, data management, data analysis, manuscript writing.
This work was funded in part by a grant from the Patient-Centered Outcome Research Institute (PCORI #ME-1306-00781) to Dr. Rapkin. This project was supported by the Michael and Zena Wiener Family Bladder Cancer Fund, Pin Down Bladder Cancer Foundation, Sidney Kimmel Cancer Center for Prostate and Urologic Cancers, and a National Institutes of Health Support Grant (NCI 2P30 CA08748-50) that partially supported the Patient-Reported Outcomes, Community-Engagement, and Language Core Facility used in completing this investigation. Dr. Feuerstein was supported by the National Cancer Institute/National Institutes of Health under Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant T32 CA082088.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.National Cancer Comprehensive Network. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2018, 2018Google Scholar
- 3.Advanced Bladder Cancer Overview, C.: Neoadjuvant chemotherapy for invasive bladder cancer. Cochrane Database Syst Rev: CD005246, 2005Google Scholar
- 18.Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, AbingdonGoogle Scholar
- 20.IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM CorpGoogle Scholar