Quality of Life and Symptom Burden in Bladder Cancer Patients Receiving Immunotherapy - Expert Commentary

Quality of life in patients with advanced urothelial cancer is determined mainly by disease symptoms and treatment side effects. Unfortunately, studies evaluating health-related quality of life (HRQoL) among patients with advanced urothelial carcinoma undergoing immunotherapy are lacking.

Schneidewind et al., therefore, aimed to evaluate HRQoL in a prospective clinical study. This study assessed HRQoL using a tool specific to immunotherapy, the Functional Assessment of Cancer Therapy – Immune Checkpoint Modulator (FACT-ICM). This assessment tool also contains scores for general FACT (FACT-G). Fourteen patients treated with pembrolizumab were included in the study. The mean age was 73.9 years. The cohort consisted of eleven males and three females. Physical well-being was lowest during therapy, with a mean score of 7.5 at the start of treatment and 4.0 at 6 months of treatment. On the other hand, emotional well-being increased during treatment, with a mean score of 9.5 at the start of treatment and 11.0 at 6 months of treatment. The difference was highly significant for both measures of well-being. When taken together, overall FACT-G scores were not significantly different throughout the treatment duration. In the FACT-ICM, symptom burden was relatively low and did not exhibit significant changes over time. Sleep issues, dry skin, and fatigue were the most commonly reported symptoms. The median overall survival time among the cohort is 8.3 months and was not affected by low HRQoL. However, a high symptom burden was associated with a significant reduction in survival. 

This study supports the feasibility of using self-reporting tools for monitoring well-being. It also validates the use of FACT-G and FACT-ICM in patients receiving immunotherapy. However, the small sample size was a limitation, and more extensive studies are needed to validate these findings.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine


  1. Schneidewind L, Dräger DL, Roßberg V, Nolting J, Hakenberg OW. Prospective Evaluation of Health-Related Quality of Life in Patients with Metastatic Urothelial Carcinoma Undergoing Immunotherapy with Pembrolizumab: Symptom Burden Can Predict Survival [published online ahead of print, 2022 Oct 14]. Urol Int. 2022;1-7. doi:10.1159/000526962
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