Quality of life in patients with invasive bladder cancer who cannot undergo cystectomy

ABSTRACT Background: To evaluate the quality of life in a bladder preservation strategy for patients with invasive bladder cancer, who are not eligible or refuse surgery. Methods: From January 2000 to February 2008 a total of 24 patients [mean age of 81 years - range 68 to 92] with muscle invasive bladder cancer, who had refused or had not been eligible for cystectomy, were followed up until their death. Results: 24 (21M/3F) patients were followed up for an average of 30.9 [range 10.4 - 73] months. All patients complained of frequency, urgency and severe nocturia. The second most frequent complication was bleeding, which required a salvage cystectomy in 11 cases. Other major complications were intestinal occlusion in five cases, four enterovesical fistulas, two brain metastases requiring neurosurgical intervention and radiation therapy of the brain, bone metastases in the cervical and thoracic spinal column with transient or permanent neurological impairment. The average re-admission rate was 11 times per patient and the average time spent at the hospital was 155 [range 13-256] days. Conclusion: We failed to give the patients a good remaining lifespan and we were surprised first, by the high cancer specific mortality rather than mortality related to a major comorbidity; second, by the insufficient patient assessment by all of the involved parties and third, how heavily the quality of life was compromised and how helpless us caregivers were. Therefore acting is better than reacting.