Quality of Life in Bladder Cancer: A Comparative Study on Cystectomy vs. Bladder Preservation - Vedang Murthy
October 10, 2023
Vedang Murthy discusses his study on the quality of life in bladder cancer patients undergoing either cystectomy (surgery) or bladder preservation (chemo-radiotherapy). The study aims to fill a gap in understanding how each treatment impacts patients' quality of life, especially since recent research suggests that both treatments offer similar clinical outcomes. Surprisingly, the study found no significant difference in functional scores between the two groups, except in the area of sexual function, which was better for patients who underwent radiotherapy. Dr. Murthy emphasizes the importance of focusing on quality of life when discussing treatment options with patients. He also mentions that a more comprehensive, prospective study is in the works to provide robust data on this subject. The conversation concludes with Dr. Murthy advocating for a patient-centric approach in treatment discussions.
Biographies:
Vedang Murthy, MD, DNB, DipEPP, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging, Banner Health MD Anderson Cancer Center, Arizona
Biographies:
Vedang Murthy, MD, DNB, DipEPP, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging, Banner Health MD Anderson Cancer Center, Arizona
Related Content:
ASTRO 2023: Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation
AUA 2023: Bladder Preservation in Muscle Invasive Bladder Cancer: Myth or Reality
Busting Common Myths Regarding Bladder Preservation for Muscle Invasive Bladder Cancer - Nick James & Ananya Choudhury
ASTRO 2023: Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation
AUA 2023: Bladder Preservation in Muscle Invasive Bladder Cancer: Myth or Reality
Busting Common Myths Regarding Bladder Preservation for Muscle Invasive Bladder Cancer - Nick James & Ananya Choudhury
Read the Full Video Transcript
Phillip Koo: Hi, my name is Phillip Koo from UroToday. We have the pleasure this year of covering ASTRO 2023 here in San Diego, California, and as always, there's a lot of buzz surrounding multiple different topics. One of the topics that we're here to discuss is a study being presented titled "Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation". We have with us the first author, Dr. Vedang Murthy, who is a professor of radiation oncology from Tata Memorial Hospital. Thank you very much for joining us.
Vedang Murthy: Absolute pleasure, Phil.
Phillip Koo: So, before we get started, I want to talk about your vest, your jacket you have on. I know there's a wonderful history there. Can you educate many of the viewers?
Vedang Murthy: This is called a Nehru jacket. It's named after the first Prime Minister of India, Jawaharlal Nehru, and has been more recently popularized by our current prime minister and it's, I think, very cool.
Phillip Koo: Yeah, it looks great.
Vedang Murthy: In hot San Diego.
Phillip Koo: I'm going to have to get myself one of those next time I see one.
Vedang Murthy: Yes.
Phillip Koo: So, let's start off talking about this study. Can you give us an overview of the background and why it was started?
Vedang Murthy: When locally advanced bladder cancer is treated, there are two ways of doing it. One is surgery and the other is to avoid surgery and treat with chemo-radiotherapy. Over the last several decades, there's been a debate about which one is better. Surgery has always been called the gold standard, but more recently, in fact, there was a very landmark paper in The Lancet Oncology a few months ago, that showed the outcomes of surgery and radiotherapy are the same. When the outcomes are the same, the quality of life should take central focus, and that was the purpose of doing this study.
Phillip Koo: So, that's great. Now, we have a landmark paper that shows clinical outcomes between these two options being equivalent, and then you're right, it really does come down to quality of life. How do we minimize those toxicities? So, can you talk about how you designed this trial looking at quality of life comparing these two treatment options?
Vedang Murthy: This study was prospectively done. It was actually very interesting. It was part of one of my MD student's thesis. So, we had planned to recruit 150 patients. We had expected about a hundred patients for cystectomy and 50 patients for bladder preservation over two years, but Covid hit and we had to restrict it to 104. These patients had had their treatment previously, so they had their curative treatment, either one of these, and they were on follow-up. Anytime after six months of their treatment, and once we ensured that they were cured, we used two quality of life instruments on them at one point, so that's why it's called a cross-sectional study, anywhere from 18 months to three years after their treatment, and studied what is the impact of their treatment on their quality of life. So, there were a total of 104 patients. There were slightly more in the surgery group than radiotherapy, and we got these results.
Phillip Koo: And this was all at your facility?
Vedang Murthy: It was all done in one hospital, Tata Memorial Hospital in Mumbai, India.
Phillip Koo: The demographics between the surgery versus bladder preservation, were they similar as well?
Vedang Murthy: Actually, interestingly, they were not. In a randomized trial, or in a trial that randomizes patients equally into two groups, you would expect the demographics to be the same, but because this was not randomized, we found that just like it would happen in practice, patients who had undergone surgery were slightly younger, about five years on average younger, than those who had undergone radiotherapy. They had more advanced disease. They received more chemotherapy, and they have had a longer follow-up. So, they were not balanced.
Phillip Koo: So, that makes sense. All right, so let's get to the exciting part. What were some of the results that you saw from your study?
Vedang Murthy: The first thing we saw surprised us a little bit. We expected that patients who had undergone surgery and had a urostomy bag would be quite miserable in both their function and their quality of life, but that was not the case. We used the EORTC QLQC-30 and the University of Michigan Bladder Cancer Index. We used these two instruments. The functional scores were quite high for both groups and they were not different between surgery and radiotherapy. So, that was the first surprise. We looked at bother and function for urinary and bowel domains in these instruments and there was no difference in any domain between surgery and radiotherapy. What was different, again, came as a bit of a surprise to us. The sexual function and sexual bother on the BCI were low for both treatments, which is kind of expected after a significant treatment, but it was better for radiotherapy than surgery in this small group of patients.
Phillip Koo: That's really interesting because, from my perspective, just looking at the big picture, you would think, all right, some of the quality of life measures would be worse for surgery than for bladder preservation. What are some thoughts or hypotheses around why it was so similar, besides sexual dysfunction?
Vedang Murthy: I think that is because we did this only once. We just got a snapshot in time after two or three years of their treatment. So, we really have not captured their entire journey after treatment as to what... They could have been miserable at one time, but at the time we did it, they probably had gotten used to it. They got on with life and maybe that is one of the reasons. So, to answer that, we are just starting a prospective comparative quality of life study in our hospital. This will use the same instruments multiple times from before the treatment and every three to six months after the treatment. So, that will give us a lot of information and we are going to plug in the treatment-related toxicities into that as well. So, that will be really robust data over the next two or three years.
Phillip Koo: That sounds really exciting, and you're right, that will provide some even more robust data. So, the final question is, a lot of people are going to be watching this video and thinking about how they can apply that to their own practice, whether it's a urologist, radiation oncologist, whether it's family members or patients actually watching this video. What advice or counsel do you have for them to interpret these results, how they interpret it, and how they incorporate that into their practices?
Vedang Murthy: The first thing is, you have to believe that quality of life should be central to the discussion with patients. One must believe that radiotherapy and surgery have similar outcomes. I think that's the key. Once you have that, the discussion around the quality of life should, I think, become central when we discuss these options with patients. In fact, the surgeons could use this, saying that, look, after two or three years you'll be as good as having an intact bladder. So, that's the way I look at it and that's a win-win for everyone.
Phillip Koo: I think that's wonderful. Just in closing, congratulations. Great work you're doing with the whole team in Mumbai, and we really look forward to this next study that will be even more impactful for our patients.
Vedang Murthy: Thank you so much. My pleasure.
Phillip Koo: Hi, my name is Phillip Koo from UroToday. We have the pleasure this year of covering ASTRO 2023 here in San Diego, California, and as always, there's a lot of buzz surrounding multiple different topics. One of the topics that we're here to discuss is a study being presented titled "Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation". We have with us the first author, Dr. Vedang Murthy, who is a professor of radiation oncology from Tata Memorial Hospital. Thank you very much for joining us.
Vedang Murthy: Absolute pleasure, Phil.
Phillip Koo: So, before we get started, I want to talk about your vest, your jacket you have on. I know there's a wonderful history there. Can you educate many of the viewers?
Vedang Murthy: This is called a Nehru jacket. It's named after the first Prime Minister of India, Jawaharlal Nehru, and has been more recently popularized by our current prime minister and it's, I think, very cool.
Phillip Koo: Yeah, it looks great.
Vedang Murthy: In hot San Diego.
Phillip Koo: I'm going to have to get myself one of those next time I see one.
Vedang Murthy: Yes.
Phillip Koo: So, let's start off talking about this study. Can you give us an overview of the background and why it was started?
Vedang Murthy: When locally advanced bladder cancer is treated, there are two ways of doing it. One is surgery and the other is to avoid surgery and treat with chemo-radiotherapy. Over the last several decades, there's been a debate about which one is better. Surgery has always been called the gold standard, but more recently, in fact, there was a very landmark paper in The Lancet Oncology a few months ago, that showed the outcomes of surgery and radiotherapy are the same. When the outcomes are the same, the quality of life should take central focus, and that was the purpose of doing this study.
Phillip Koo: So, that's great. Now, we have a landmark paper that shows clinical outcomes between these two options being equivalent, and then you're right, it really does come down to quality of life. How do we minimize those toxicities? So, can you talk about how you designed this trial looking at quality of life comparing these two treatment options?
Vedang Murthy: This study was prospectively done. It was actually very interesting. It was part of one of my MD student's thesis. So, we had planned to recruit 150 patients. We had expected about a hundred patients for cystectomy and 50 patients for bladder preservation over two years, but Covid hit and we had to restrict it to 104. These patients had had their treatment previously, so they had their curative treatment, either one of these, and they were on follow-up. Anytime after six months of their treatment, and once we ensured that they were cured, we used two quality of life instruments on them at one point, so that's why it's called a cross-sectional study, anywhere from 18 months to three years after their treatment, and studied what is the impact of their treatment on their quality of life. So, there were a total of 104 patients. There were slightly more in the surgery group than radiotherapy, and we got these results.
Phillip Koo: And this was all at your facility?
Vedang Murthy: It was all done in one hospital, Tata Memorial Hospital in Mumbai, India.
Phillip Koo: The demographics between the surgery versus bladder preservation, were they similar as well?
Vedang Murthy: Actually, interestingly, they were not. In a randomized trial, or in a trial that randomizes patients equally into two groups, you would expect the demographics to be the same, but because this was not randomized, we found that just like it would happen in practice, patients who had undergone surgery were slightly younger, about five years on average younger, than those who had undergone radiotherapy. They had more advanced disease. They received more chemotherapy, and they have had a longer follow-up. So, they were not balanced.
Phillip Koo: So, that makes sense. All right, so let's get to the exciting part. What were some of the results that you saw from your study?
Vedang Murthy: The first thing we saw surprised us a little bit. We expected that patients who had undergone surgery and had a urostomy bag would be quite miserable in both their function and their quality of life, but that was not the case. We used the EORTC QLQC-30 and the University of Michigan Bladder Cancer Index. We used these two instruments. The functional scores were quite high for both groups and they were not different between surgery and radiotherapy. So, that was the first surprise. We looked at bother and function for urinary and bowel domains in these instruments and there was no difference in any domain between surgery and radiotherapy. What was different, again, came as a bit of a surprise to us. The sexual function and sexual bother on the BCI were low for both treatments, which is kind of expected after a significant treatment, but it was better for radiotherapy than surgery in this small group of patients.
Phillip Koo: That's really interesting because, from my perspective, just looking at the big picture, you would think, all right, some of the quality of life measures would be worse for surgery than for bladder preservation. What are some thoughts or hypotheses around why it was so similar, besides sexual dysfunction?
Vedang Murthy: I think that is because we did this only once. We just got a snapshot in time after two or three years of their treatment. So, we really have not captured their entire journey after treatment as to what... They could have been miserable at one time, but at the time we did it, they probably had gotten used to it. They got on with life and maybe that is one of the reasons. So, to answer that, we are just starting a prospective comparative quality of life study in our hospital. This will use the same instruments multiple times from before the treatment and every three to six months after the treatment. So, that will give us a lot of information and we are going to plug in the treatment-related toxicities into that as well. So, that will be really robust data over the next two or three years.
Phillip Koo: That sounds really exciting, and you're right, that will provide some even more robust data. So, the final question is, a lot of people are going to be watching this video and thinking about how they can apply that to their own practice, whether it's a urologist, radiation oncologist, whether it's family members or patients actually watching this video. What advice or counsel do you have for them to interpret these results, how they interpret it, and how they incorporate that into their practices?
Vedang Murthy: The first thing is, you have to believe that quality of life should be central to the discussion with patients. One must believe that radiotherapy and surgery have similar outcomes. I think that's the key. Once you have that, the discussion around the quality of life should, I think, become central when we discuss these options with patients. In fact, the surgeons could use this, saying that, look, after two or three years you'll be as good as having an intact bladder. So, that's the way I look at it and that's a win-win for everyone.
Phillip Koo: I think that's wonderful. Just in closing, congratulations. Great work you're doing with the whole team in Mumbai, and we really look forward to this next study that will be even more impactful for our patients.
Vedang Murthy: Thank you so much. My pleasure.