Original article
Dietary patterns and health-related quality of life in bladder cancer survivors

https://doi.org/10.1016/j.urolonc.2018.06.001Get rights and content

Highlights

  • Diet quality in bladder cancer survivors “needs improvement”.

  • Whole grain and vitamin D intake patterns are particularly poor.

  • Higher quality diet may be positively associated with better HRQOL.

Abstract

Purpose

A nutritious diet has been associated with better health-related quality of life (HRQOL) in a variety of cancer survivors. However, little is known about dietary habits and its association with HRQOL in bladder cancer survivors. The objective of this cross-sectional study is to describe dietary intake patterns and its relationship to HRQOL in a large cohort of bladder cancer survivors.

Methods

Bladder cancer survivors within our institutional database were mailed surveys to assess dietary intake patterns utilizing the Diet History Questionnaire II and assessing HRQOL utilizing the Functional Assessment of Cancer Therapy-Bladder Cancer. Diet quality was assessed via Healthy Eating Index 2010 scores based on subjects’ Diet History Questionnaire II results. Univariate and multivariate analyses of HRQOL based on diet quality were used to evaluate whether diet quality was associated with HRQOL.

Results

Four hundred and fifty-nine patients (48%) returned questionnaires. Mean age was 74 years, 81% were male and 28% underwent radical cystectomy. Diet quality and quantity in our cohort was similar to the general older U.S. population and did not differ significantly between those managed conservatively or long-term following cystectomy. Our cohort had low intake of whole grains and fat-soluble vitamins, particularly vitamin D. Diet quality was significantly associated with HRQOL in the univariate analysis but lost statistical significance in our multivariate analysis. Elixhauser Comorbidity Index was significantly associated with HRQOL in the multivariate analysis.

Conclusions

This study demonstrates a similar diet quality of bladder cancer survivors to the older general U.S. population that, on average, “needs improvement.” Dietary intake is particularly lacking in whole grain and vitamin D intake. Future studies are warranted to determine the impact on long-term outcome, but bladder cancer survivors should be counseled on the importance and benefits of adherence to dietary guidelines, including its potential contribution toward better HRQOL.

Section snippets

1. Introduction

Society and medicine are placing an increasing emphasis on cancer survivorship [1]. As the population continues to age and cancer treatment evolves, the number of cancer survivors is expected to increase. Greater numbers will then be faced with the physical and psychosocial challenges of recovering from cancer and its treatment [2], [3]. This population is already known to have elevated risks of mortality and chronic health conditions [4]. Thus, it is important to align our goals of increased

2.1. Subjects

After approval by the Duke University Health System Institutional Review Board, potential subjects were identified through an institutional database and screened on predefined inclusion and exclusion criteria. Inclusion criteria were: (1) age ≥ 18 years, (2) history of care at our institution, and (3) histologically confirmed diagnosis of bladder cancer. Exclusion criteria were: (1) deceased, (2) inability to read/write English, (3) last known follow-up > 2 years prior, and (4) known cognitive

3.1. Survey response

Nearly half of subjects returned surveys (459 of 952). Clinicodemographic characteristics are summarized in Table 1. Female gender, current smoking status and longer time to last procedure were associated with lower odds of response (P < 0.005; 11 variables). Among respondents, the majority of subjects had low-stage disease and underwent transurethral resection as the primary procedure. Most subjects that underwent radical cystectomy received an ileal conduit. Only 5 subjects who returned

4. Discussion

To the best of our knowledge, this study is the largest to comprehensively assess diet quality and dietary patterns in bladder cancer survivors. Dietary patterns in our cohort were similar to the age-matched general U.S. population and prior cancer survivorship studies [1]. The average diet quality is one that “needs improvement” according to the HEI 2010. Both diet quality and dietary patterns did not differ significantly between those managed conservatively or via extirpative surgery. The

5. Conclusions

This large cohort of bladder cancer survivors had moderate adherence to the USDA's Dietary Guidelines for Americans with dietary patterns very similar to the older general U.S. population. Diet was not significantly different between those managed conservatively and long-term survivors following radical cystectomy. Compared to USDA recommendations, our cohort had particularly low intake of whole grains and fat-soluble vitamins, including vitamin D. Diet quality was significantly associated with

Conflict of interest

None.

Acknowledgments

I would like to acknowledge Dr. Kevin Weinfurt and Dr. Maragatha Kuchibhatla for their valuable input in the critical revision of this manuscript. They did not receive any compensation for their contributions.

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    Funding: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR001116. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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