Adjuvant HRQOL Outcomes in Genitourinary
Cancers | Image Credit: © Sebastian Kaulitzki
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Health-related quality of life (HRQOL) outcomes following radical cystectomy were better among patients with bladder cancer who were residents of rural areas compared with those who resided in urban areas, according to findings from a study conducted at the Ludwig-Maximilian University of Munich in Germany that were presented at the 2025 Genitourinary Cancers Symposium.1
Furthermore, a second study conducted at the Ludwig-Maximilian University of Munich showed that among patients who underwent radical prostatectomy, the addition of androgen deprivation therapy (ADT) to adjuvant radiotherapy generated worse HRQOL outcomes compared with adjuvant radiotherapy alone; the negative HRQOL effects of ADT increased with longer duration of ADT.2
Residential-Specific HRQOL Effects of Radical Cystectomy on Patients With Bladder Cancer
During short-term follow-up, this prospective and longitudinal analysis found that patients with bladder cancer living in rural areas reported better general HRQOL vs those residing in urban areas (P = .001-.037).1 However, at 12 months, both urban and rural residents had a significant correlation between better overall HRQOL and better physical functioning, emotional functioning, and urinary continence (each P < . 001). The study also found a significant correlation between social/family wellbeing and increased HRQOL for rural residents (P = .042), but the same was not observed for urban residents (P = .594).
“Physical- and emotional functioning equally affects HRQOL for rural and urban residents, while social/family wellbeing correlates with increased general HRQOL for rural residents only,” lead study author Thilo Westhofen, MD, from Ludwig-Maximilian University of Munich, Germany, and coauthors wrote in the poster.
Overall, 1514 patients were included in this analysis. Patients were prospectively assessed using patient-reported outcome measures including the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionaire (QLQ)-C30, the QLQ-BLM30, and the Functional Assessment of Cancer Therapy-Bladder (FACT-BL).
Overall, 576 patients were from urban areas, and 938 patients were from rural areas. Patients who underwent radical cystectomy at a large tertiary care center were included in the analysis. The investigators used Spearman’s rank correlation to identify residential-specific factors that influence HRQOL.
The authors noted that patients from rural areas may have more difficult access to health care vs those from urban areas. This disparity may have detrimental effects on oncologic outcomes after a radical cystectomy. Prior to this study, there was not much known about the HRQOL effects between rural and urban residents undergoing radical cystectomy.
HRQOL After ADT and Postoperative Radiotherapy in Prostate Cancer
This analysis included 1124 patients who underwent radiotherapy after previous radical prostatectomy.2 Patient-reported outcome measures were analyzed using EORTC QLQ-C30 and QLQ-PR25 questionnaires. A separate model was used for the longitudinal analysis of HRQOL in patients who received ADT vs those who did not. A correlation analysis and multivariable regression models were used to estimate the effects of ADT plus postoperative radiotherapy on HRQOL.
For the patients in the ADT cohort, the median duration of ADT was 21 months. Additionally, there was no significant difference in HRQOL by global health status (GHS) domain for those who had undergone prior radical prostatectomy and radiotherapy.
The longitudinal analysis found a significantly worse GHS score in the ADT cohort up to 48 months after radical prostatectomy (P = .001-.039). The multivariable regression analysis determined that ADT was an independent predictor of worse general HRQOL (odds ratio [OR], 0.68; 95% CI, 0.47-0.96; P = .03). Other factors contributing to worse HRQOL were erectile functioning (OR, 5.241; 95% CI, 2.48-11.06; P = .001) and urinary continence (OR, 1.655; 95% CI, 1.03-2.66; P = .037). There was also a correlation between a longer duration of ADT and worse long-term general HRQOL (P < .001).
References
Westhofen T, Buchner A, Schulz G, et al. Differences in health-related quality of life between rural and urban bladder cancer patients following radical cystectomy. J Clin Oncol. 2025;43(5):766. doi:10.1200/JCO.2025.43.5_suppl.766
Westhofen T, Buchner A, Eismann L, et al. Impact of androgen deprivation therapy with postoperative radiotherapy after radical prostatectomy on health-related quality of life. J Clin Oncol. 2025;43(5):133. doi:10.1200/JCO.2025.43.5_suppl.133