Distressful symptoms after radical radiotherapy for urinary bladder cancer

Abstract

Background: Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy.

Materials and methods: We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 individuals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias.

Results: Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free.

Conclusions: About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.

Introduction

In muscle-invasive urinary bladder cancer – a life-threatening disease – radiotherapy offers an attractive treatment choice, as it sterilizes the tumour while maintaining organ function. Many centres regard cystectomy as the primary therapy of choice. The urinary diversion may result in major physical and psychological changes that may chronically affect well-being [8], [13], [14], [15], [16], [17]. The function of the urinary bladder may be altered during irradiation [10]. Moreover, organs at risk include the bowel (primarily the rectum), anal sphincter, lymph vessels and the nerves and vessels involved in sexual function. A better knowledge of chronic distressful symptoms after radiotherapy can be used to prevent or relieve side effects, guide improvements in radiotherapeutic techniques and help patients to make informed treatment choices.

The rapid technological developments in radiotherapy imply that the generalizability of any historical series in today's situation at different centres is a matter of judgement. Here we report the frequencies of common distressful symptoms after radical radiotherapy for urinary bladder cancer and compare the results with those in cystectomized individuals with a urostomy and in population controls. The results reflect radiotherapy in Stockholm as given during 1977–1995.