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Adherence to lifestyle recommendations may improve health-related quality of life in patients with non-muscle invasive bladder cancer.

The effect of lifestyle on health-related quality of life (HRQOL) is well-established for various types of cancer. However, limited evidence is available from cross-sectional studies for non-muscle invasive bladder cancer (NMIBC). There is a lack of longitudinal data on lifestyle and HRQOL to assess the changes following the diagnosis. A study published in the International Journal of Cancer has assessed, for the first time, the longitudinal associations between HRQOL and adherence to lifestyle recommendations by the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/ AICR)  in NMIBC patients.

Study Population

A total of 1029 patients were enrolled in the study, of which, 80% of patients were male. The mean age at diagnosis was 65.9 years. Data was collected at 6 weeks (6wk, baseline), 3 months (3mo), and 15 months (15mo) after diagnosis.

Lifestyle Recommendations and HRQOL During the Follow-up Period

The mean WCRF/ AICR adherence score was 3.3 at baseline. Varied adherence was observed between different recommendations. While the adherence score remained constant over time, some changes were noted in adherence to individual recommendations. From 6wk to 15mo, global quality of life, role, and social functioning increased while physical functioning decreased. No significant change in fatigue was observed.

Association of Adherence Score and HRQOL Outcomes

Higher adherence to lifestyle recommendations (a one-point increase in the WCRF/ AICR score) was significantly associated with better global quality of life, physical, role, and social functioning and less fatigue in the 15mo follow-up period after diagnosis.

Impact of Adherence to Lifestyle Recommendations on HRQOL

Assessment of the WCRF/ AICR score components revealed that better adherence to the body mass index recommendation was significantly associated with better physical functioning. Moderate-to-vigorous physical activity for more than 150 min/week and a higher dietary score were significantly associated with better HRQOL outcomes. Adherence to alcohol recommendation (i.e. abstinence) was significantly associated with worse HRQOL outcomes.

Interindividual associations were stronger than intraindividual associations, implying that between-subject differences mainly drove the associations. Further research is needed to determine causative links between lifestyle and HRQOL.


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Vidra, N., Beeren, I., Winkels, R. M., Aben, K. K., Kampman, E., Witjes, J. A., Van Der Heijden, A. G., Kiemeney, L. A., & Vrieling, A. (2023). Longitudinal associations of adherence to lifestyle recommendations and health‐related quality of life in patients with non‐muscle invasive bladder cancer. International Journal of Cancer, 152(10), 2032–2042. https://doi.org/10.1002/ijc.34418