The Impact of Intravesical Instillations on Quality of Life in Patients with Non-Muscle-Invasive Bladder Cancer: A Systematic Review

Intravesical therapy has been a standard treatment pathway for non-muscle-invasive bladder cancer (NMIBC) for decades. There is evidence from randomized controlled trials that BCG and chemotherapy instillations can delay recurrence and reduce progression risk. However, while most studies have focused on the efficacy of intravesical treatments, little attention has been given to the lived experience of patients undergoing these repeated treatments. That absence in the literature is what initially drove us to explore this topic in more depth.

As we analyzed the studies, a very consistent picture emerged. Patients often described urinary symptoms—including urgency, pain, nocturia, and loss of bladder control, especially during the early cycles. These physical symptoms did not occur in isolation; they affected sleep, social interaction, emotional well-being, and confidence. Fatigue was another recurring issue and, in some cases, persisted well after treatment cycles finished.

What stood out most was the effect of treatment burden on adherence. Several studies reported that many patients simply did not complete their planned course of therapy. In some cases, discontinuation rates approached 90%. Reasons varied, but they were relatable: painful instillations, discomfort, travel demands, repeated visits, and the sense that the treatment was dominating daily life. It was particularly evident that older adults struggled more with completing treatment. Since the average age for bladder cancer is 74 years, elderly patients make up most of the patients.

One message came through clearly from patient reflections: if fewer instillations could achieve the same clinical benefit, patients would overwhelmingly prefer that option. And truthfully, after examining the evidence, it’s difficult to argue with them.

There is now increasing interest in whether modified schedules or newer therapies may offer a better balance between maintaining cancer control and reducing treatment burden. Early findings are encouraging, but we still need more comparative data before changing practice.

For us, this review reinforced something essential: clinical outcomes are only one part of the story. Quality of life should be considered just as seriously as recurrence curves or progression timelines. Regular use of patient-reported outcomes in trials and in practice would help ensure treatment decisions reflect not only tumour biology, but also the real-world experience of people living with this disease.

With new therapeutic options now emerging that may reduce instillation frequency, we have an opportunity and perhaps a responsibility to rethink how we measure success in NMIBC. The goal should be not only to prolong life, but to make sure patients can live well while undergoing treatment.

Written by: Ingolf Griebsch,¹ Sunil Shrestha,^2,3 Yair Lotan,⁴ Chi-Fai Ng,⁵ Andrew Bottomley⁶

Global Health Economics and Outcome Research, Ferring Pharmaceuticals A/S, Ferring International PharmaScience Center, Copenhagen, Denmark.
Department of Research and Academics, Kathmandu Cancer Center, Tathali, Nala Road, Bhaktapur, Nepal.
Person-Centred Research, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
Vice Chair of Clinical Affairs, Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, MD, Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA.
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
Bottomley Consulting Group, Brussels, Belgium.

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