Longitudinal assessment of patient-reported quality of life and mental health during active surveillance for low-grade NMIBC.

Abstract

727 Background: While transurethral resection of bladder tumor (TURBT) remains the gold-standard treatment for non–muscle-invasive bladder cancer (NMIBC), there is growing interest in de-intensification strategies aimed at reducing the patient burden of repeated procedures and the overall economic impact of the disease. Active Surveillance (AS) has been proposed as a potential alternative to TURBT in selected cases of recurrent low-grade (LG) NMIBC, with promising oncologic outcomes. However, the impact of AS on patients’ quality of life (QoL) remains largely unexplored. This study aimed to evaluate longitudinal changes in QoL during AS for LG NMIBC, with a secondary objective of identifying patient subgroups at increased risk of QoL deterioration. Methods: Prospective data were collected from patients enrolled in the Bladder Cancer Italian Active Surveillance (BIAS) project, an ongoing AS protocol initiated at our institution in January 2013, which has included a total of 231 individuals to date. Overall, 48 patients had at least 12 months of follow-up and complete paired QoL data. QoL was assessed at baseline and at 12 months using the EORTC QLQ-C30, EORTC QLQ-NMIBC24, and EQ-5D-5L questionnaires. Paired t-tests compared baseline and 12-month scores, while subgroup analyses by age ( < 70 vs ≥70 years) and sex were performed using Mann–Whitney U tests. Results: Median age was 66 years (IQR 59–77); 18 patients (38%) were female. Median follow-up was 16 months (IQR 14–24). Global health status and domain-specific QoL scores remained stable over time across all instruments. Median EORTC QLQ-C30 global health scores were 97 (IQR 95–99) at baseline and 93 (IQR 88–95) at 12 months. Median EQ-5D-5L index values were 0.92 (IQR 0.88–1.00) and 0.89 (IQR 0.85–0.95), respectively. No statistically significant differences were observed in overall QoL scores or in subgroup analyses by sex or age group (all p > 0.05). Patients aged ≥70 years showed a non-significant trend toward higher depressive symptom scores, likely reflecting age-related health decline rather than cancer-related distress. Median EORTC QLQ-NMIBC24 scores demonstrated overall stability between baseline and 12 months, with no significant changes across any domains. No patients discontinued active surveillance during follow-up. Conclusions: This is the first study specifically assessing QoL in patients undergoing AS for recurrent LG NMIBC. Our data suggest that AS preserves overall QoL and psychological well-being over at least 12 months of follow-up. These findings support AS as a safe and well-tolerated management strategy for appropriately selected patients, with no evidence of QoL deterioration over time. Further efforts are warranted to identify individuals who are at risk of psychological distress, to ensure timely and appropriate supportive interventions aimed at preserving overall well-being.