Lung, prostate and bladder cancer are amongst the top ten most prevalent cancers in Europe[1] yet more needs to be done to encourage earlier diagnosis, as well as prioritising quality of life at every stage of the treatment journey, to give patients the best chance of living a longer and better life.[2],[3],[4]

Dr Cathy Taylor, Vice President EMEA Medical Affairs, Therapy Area Strategy at Janssen discusses how a diagnosis with these solid tumour-type cancers impacts a patient’s daily life, with a particular focus on quality of life.

How does a diagnosis with a urological cancer like prostate or bladder impact a patient’s quality of life?

“First and foremost, a diagnosis with any cancer can have a major impact on a person, not just physically, but also in terms of our emotional, psychological and social well-being. Having treated many Oncology patients, I have seen a wide spectrum of emotions including fear, anxiety, sadness and even embarrassment. [5] Depending on the stage at which people are diagnosed, whether it is localised, locally advanced or metastatic, all present different challenges and different conversations.  

Focusing on intimate parts of the body such as prostate and bladder cancer specifically, patients are likely to be concerned about the impact of the disease on their urinary, bowel and sexual function, the impact on their relationship with their partner and even stigma from others.[6],[7]  

The Europa Uomo study examines quality of life after treatment for prostate cancer and collected information from approximately 3,000 prostate cancer patients. It highlighted half of all men felt sexual function was either a moderate or big problem after treatment, while patients’ sex-life was identified as the most significant factor affecting quality of life[8]. A survey of almost 2,000 people living with bladder cancer uncovered similar findings, with sexual problems commonly reported - particularly in men.[9] Physical issues such as these, which can lead to further psychological issues, need to be considered when selecting a specific treatment – so that quality of life and better outcomes can be prioritised.  

Impact on body image, self-esteem, and masculinity are also correlated with a bladder or prostate cancer diagnosis, with significant effects on quality of life.[10] In more invasive bladder cancer, a radical cystectomy (bladder removal) can profoundly affect self-image, with people having to adjust to having a urostomy bag or stoma. Many women may find that the vaginal shortening often performed during bladder removal surgery makes it difficult for them to be able to function sexually compared to before. Prostate removal (prostatectomy) can also lead to erectile dysfunction.[11]

These are just some of the aspects of quality of life that are affected by a urological cancer diagnosis, but of course, factors such as professional life, family life, leisure activities and finances can also be negatively impacted.[12]” 

What key aspects of quality of life are affected by a lung cancer diagnosis?

“Lung cancer has a particularly poor prognosis; one in five cancer deaths in Europe are from lung cancer, which is more than breast and prostate cancer combined.[13] Around three-quarters of non-small cell lung cancer cases (the most common form of the disease)[14] are diagnosed at a late stage of the disease (III/IV)[15], resulting in a median five-year survival rate of less than 20%.[14]

These sobering statistics mean that people with lung cancer and their families/caregivers face a significant emotional burden, sometimes viewing their diagnosis as a death sentence and experiencing feelings of uncertainty, depression and fear.[16]

A lung cancer diagnosis is also likely to cause physical changes, which in turn can have a psychological impact. A 2021 survey by Lung Cancer Europe found that two thirds of patients experience fatigue and over half experience a cough or breathlessness, which can lead to anxiety. [17] Fatigue is the main barrier to carrying out physical activities, which can actually help to improve symptoms, functional capacity and quality of life.[16] As with bladder and prostate cancer, sexual intimacy is also affected; over half of respondents reported a negative or very negative impact on sexual intercourse.[17]

How can we seek to address these challenges across solid tumours?

“We need to ensure that patients and their caregivers have access to support and information about the impact of a particular cancer and what to expect from treatment.  This keeps them informed and empowered on their journey and know which questions to ask. Further collaboration between healthcare professionals (HCPs) and patient organisations help to improve the quality of support information for patients.

Another factor is facilitating better communications between patients and HCPs during consultations to enable shared decision making and the development of individualised care plans which prioritise quality of life.[16]This also concerns end-of-life care, making sure we encourage and support discussions with people impacted by cancer and caregivers to explore people’s expectations and wishes.[16]

Working closely with patient groups to provide accurate information and support is key, as well as encouraging open and healthy conversations between patients and HCPs to ensure patients are taking a more active role in their treatment and management. Specialist nurses can play a big role in providing dedicated support and guidance for patients across the spectrum, including areas like sexual wellbeing, making a real difference to quality of life and outcomes.[11]

We have also made big strides in terms of precision medicine in solid tumours, which focuses on targeting the genetic drivers of specific types of cancer, paving the way for novel and tailored therapeutic approaches.[18] By adapting to the genetic makeup, lifestyle and environment of every patient, we have the best chance of selecting the right treatment and reducing over-treatment, which can have a substantial burden on a patient’s quality of life.[19]

For more information on Janssen in Oncology, please visit:

https://www.janssen.com/emea/our-focus/oncology

References

[1] WHO.EUROPE, Globocan 2020 web. Available at: https://gco.iarc.fr/today/data/factsheets/populations/908-europe-fact-sheets.pdf. Last accessed September 2022

[2] Mohamad S, et al. Promoting lung cancer awareness, help-seeking and early detection: a systematic review of interventions, Health Promotion International, Volume 36, Issue 6, December 2021, Pages 1656–1671, https://doi.org/10.1093/heapro/daab016

[3] WBCPC, Raising awareness. Available at: https://worldbladdercancer.org/our-work/raising-awareness/ Last accessed September 2022

[4] Prostate Cancer UK. Public Awareness Study. Available at: https://prostatecanceruk.org/about-us/projects-and-policies/public-awareness-study Last accessed September 2022

[5] https://www.cancerresearchuk.org/about-cancer/coping/emotionally/cancer-and-your-emotions Last accessed September 2022

[6] Larkin D, et al. A systematic review of disease related stigmatization in patients living with prostate cancer. PLOS ONE 2022. 17(2): e0261557. Available at:  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261557 Last accessed September 2022

[7] Fight Bladder Cancer. Surviving bladder cancer. Available at: https://fightbladdercancer.co.uk/get-help/living-cancer/surviving-bladder-cancer. Last accessed September 2022

[8] https://www.europa-uomo.org/who-we-are/quality-of-life-2/the-euproms-study/ Last accessed September 2022

[9] EAU. Quality of Life After Bladder Cancer: A Cross-sectional Survey

of Patient-reported Outcomes.  Available at: https://www.europeanurology.com/article/S0302-2838(21)00073-7/pdf Last accessed September 2022

[10] Bowie J, et al. Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis. J Cancer Surviv. 2022 Feb;16(1):95-110 Available at: https://pubmed.ncbi.nlm.nih.gov/33963973/ Last accessed September 2022

[11] Fight Bladder Cancer. Lack Of Specialist Staff Is Leading To Quality Of Life And Sexual Wellbeing Problems For Bladder Cancer Patients. Available at: https://fightbladdercancer.co.uk/blog/lack-specialist-staff-leading-quality-life-and-sexual-wellbeing-problems-bladder-cancer Last accessed September 2022

[12] Leuteritz K, et al. Quality of life in urologic cancer patients: importance of and satisfaction with specific quality of life domains. Qual Life Res. 2022 Mar;31(3):759-767. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921173/ Last accessed September 2022.

[13] Globocan 2020. Estimated number of deaths in 2020, Europe, both sexes, all ages. Available at: https://gco.iarc.fr/today Last accessed September 2022

[14] Zappa C et al. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res 2016; 5(3): 288–300.

[15] Knight S, et al. Progress and prospects of early detection in lung cancer. Open Biol 2017; 7(9): 170070.

[16] Lung Cancer Europe. 5th LuCE Report on Lung Cancer: Psychological and social impact of lung cancer. 2021. Available at: https://www.lungcancereurope.eu/wp-content/uploads/2022/04/5th-REPORT-LuCE-2020_final-2.pdf Last accessed September 2022

[17] Lung Cancer Europe. 6th LuCE Report on Lung Cancer: Experiences and quality of life of people impacted by lung cancer in Europe 2020 Available at: https://www.lungcancereurope.eu/wp-content/uploads/2021/12/6th-LuCE-Report_Web-version_Definitive.pdf  Last accessed September 2022

[18] The Pharmaceutical Journal. The precision medicine approach to cancer therapy: part 1 — solid tumours. Available at: https://pharmaceutical-journal.com/article/research/the-precision-medicine-approach-to-cancer-therapy-part-1-solid-tumours. Last accessed September 2022.

[19] Katz SJ, et al. Reducing Overtreatment of Cancer With Precision Medicine: Just What the Doctor Ordered. JAMA. 2018;319(11):1091–1092. Available at: https://jamanetwork.com/journals/jama/article-abstract/2673741 Last accessed September 2022