JU INSIGHT Bladder Cancer Survivors Who Do Not Smoke Have Better Longitudinal Health-Related Quality of Life

By: Hannah Kay, MD, University of North Carolina at Chapel Hill; Sarah N. Silver, MD, University of North Carolina at Chapel Hill; Angela B. Smith, MD, MS, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Ramsankar Basak, PhD, University of North Carolina at Chapel Hill; Kimberly Shoenbill, MD, PhD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Deborah Usinger, BA, University of North Carolina at Chapel Hill; Adam O. Goldstein, MD, MPH, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Richard S. Matulewicz, MD, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Ronald Chen, MD, MPH, University of Kansas Medical Center, Kansas City; Marc A. Bjurlin, DO, MSc, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill | Posted on: 17 Jul 2024

Kay H, Silver SN, Smith AB, et al. Bladder cancer survivors who do not smoke have better longitudinal health-related quality of life measures: an assessment of the Comparative Effectiveness of Survivorship Health in Bladder Cancer (CEASE-BC) study. J Urol. 2024;212(1):87-94. doi:10.1097/JU.0000000000003964

Study Need and Importance

Cigarette smoking is the most common modifiable risk factor for bladder cancer, yet few studies have characterized how smoking is related to quality of life in bladder cancer patients. We sought to investigate the relationship between smoking and health-related quality of life (HRQoL) outcomes in bladder cancer patients, with the hope that our results may inform motivational and counseling efforts for smoking cessation as part of comprehensive bladder cancer care.

What We Found

Using data from a prospective, longitudinal study, we identified 126 patients who did not smoke and 28 who did smoke from a population of newly diagnosed bladder cancer patients from North Carolina. These patients completed HRQoL surveys at 3, 12, and 24 months after diagnosis. When controlling for time from diagnosis, demographic covariates, and treatment received, those who did not smoke had significantly better physical function and emotional functions, and less fatigue compared to those who smoked (Table).

Limitations

Small sample size and self-reported smoking status likely mean we underreported the true smoking rate or its effect. We did not assess smoking status at time of diagnosis, and patients may have quit between diagnosis and the first survey at 3 months. We dichotomized patients as smoker and nonsmoker and could not further differentiate current, former, and never smokers. Together these may have limited additional granularity to the analysis.

Interpretation for Patient Care

Our study shows that bladder cancer patients who abstain from smoking tend to experience better HRQoL. These findings emphasize the importance of integrating smoking cessation into comprehensive bladder cancer care, not only for its impact on disease and treatment outcomes, but also for its influence on overall quality of life. Our results indicate the utility of smoking cessation interventions tailored to patients’ individual goals and values regarding their quality of life.

Table. Multivariable Regression Analysis Examining the Effect of Current Smoking Status on Quality of Life Domains

QLQ domain	Multivariable model^a parameter estimate (95% CI)	P value
Function
Physical function
Nonsmoker^b	7.4 (2.4, 12.3)	< .01c
Emotional function
Nonsmoker	5.6 (0.9, 11.2)	.047c
Fatigue
Nonsmoker	−8.2 (−14.4, −1.9)	.01c
Other
Financial difficulties
Nonsmoker	−5.4 (−14.6, 3.9)	.2
Global health status
Nonsmoker	2.5 (−3.1, 8.1)	.3
Abbreviations: QLQ, Quality of Life Questionnaire.
^aCovariates included gender, race, age binary at 65, time from diagnosis (discrete), staging, and 2 time varying dummies for treatment types: (1) any partial cystectomy, or radical cystectomy, and (2) any intravesical chemotherapy, bacillus Calmette-Guérin, radiation, or transurethral resection of bladder tumor.
^bThe reference group in all analyses was current patients who smoke.
^cDifference was statistically significant (alpha < .05).