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Quality of Life in Non-Muscle-Invasive Bladder Cancer Survivors

A Systematic Review

Jung, Ahrang, PhD, RN; Nielsen, Matthew E., MD, MS, FACS; Crandell, Jamie L., PhD; Palmer, Mary H., PhD, RN, FAAN, AGSF; Bryant, Ashley Leak, PhD, RN-BC, OCN; Smith, Sophia K., PhD; Mayer, Deborah K., PhD, RN, AOCN, FAAN

doi: 10.1097/NCC.0000000000000606

Background Non-muscle-invasive bladder cancer (NMIBC) represents approximately 75% of newly diagnosed patients with bladder cancer. Non-muscle-invasive bladder cancer survivors have unique chronic burdens including frequent recurrences, repeated surveillance cystoscopies and treatments, and the highest lifetime medical cost per person among all cancers.

Objective The purpose of this study was to summarize studies assessing quality of life (QOL) in NMIBC survivors.

Methods The literature from January 2005 to March 2017 found in PubMed, CINAHL, and PsycINFO databases was reviewed systematically. Inclusion criteria were as follows: (1) research about NMIBC survivors, (2) outcomes included QOL, (3) original research article published in peer-reviewed journals, and (4) published in English.

Results A total of 15 studies were included: 14 quantitative studies and 1 mixed-methods study. Non-muscle-invasive bladder cancer survivors had significantly lower QOL compared with the general population, especially in fatigue, physical and role functioning, and mental health. Repeated transurethral resections and intravesical treatments were associated with impaired physical function and mental health. Most NMIBC survivors had concerns of urinary and bowel problems and sexual function.

Conclusion Despite a good prognosis, NMIBC and its treatment have a significant impact on QOL in survivors. The findings showed large burdens in NMIBC survivors and suggest that further research is needed to better understand potential opportunities to improve QOL in this population.

Implications for Practice Oncology nurses are in the critical position for assessing symptoms and concerns. Oncology nurses should pay special attention to NMIBC survivors who have unique symptoms and burden with the aim of improving survivors' QOL.

Author Affiliations: School of Nursing (Drs Jung, Crandell, Palmer, Bryant, and Mayer), School of Medicine (Dr Nielsen), and Lineberger Comprehensive Cancer Center (Drs Nielsen, Bryant, and Mayer), The University of North Carolina at Chapel Hill; and School of Nursing, Duke University, Durham, North Carolina (Dr Smith).

Support has been provided from the Cancer Outcomes Research Program Research Award, Lineberger Comprehensive Cancer Center, UNC; Alpha Chapter Research Grant, Sigma Theta Tau International; and Linda Waring Matthews Research Fund Scholarship (to A.J.).

The authors have no conflicts of interest to disclose.

Correspondence: Ahrang Jung, PhD, RN, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (

Accepted for publication February 19, 2018.

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