A quarter less chance of bladder cancer recurrence with healthy lifestyle Better prognosis with healthy weight, exercise and good nutrition

Patients with bladder cancer who live healthy have a quarter less chance of recurrence of the disease, according to a study by Radboud university medical center. The researchers followed nearly 900 patients for years with questionnaires. They looked at the total package of a healthy weight, sufficient exercise and good nutrition, as advised by the World Cancer Research Fund (WCRF).

For the first time, the effect of a healthy lifestyle after diagnosis has been studied on bladder cancer recurrence. Previous research has shown that healthy living reduces cancer risk, but this is one of the first studies to look specifically at disease recurrence. ‘Bladder cancer returns very often after the initial surgery, in as many as about half of the cases’, says nutrition and cancer epidemiologist Alina Vrieling. ‘Patients therefore receive many check-ups and often new treatments. That's an intensive trajectory.’

Healthy lifestyle score

The researchers wondered whether a healthy lifestyle could lower the risk of disease recurrence. They therefore followed 885 patients from 22 Dutch hospitals for an average of 3.5 years. They had bladder cancer that had not yet grown into the bladder muscle, about three-quarters of all bladder cancers. ‘These people filled out questionnaires about their lifestyle before diagnosis and three months afterwards’, says researcher Moniek van Zutphen. ‘And they gave permission to get insight in their medical data.’

The researchers converted the results of the questionnaires into a score for healthy lifestyle. They used the WCRF's healthy lifestyle recommendations on weight, exercise and nutrition. They recommend lots of vegetables, fruit and whole grain products, and little alcohol, red and processed meat, ultra-processed foods and sugar-containing drinks. Van Zutphen: ‘We weighed the whole package of advice into the score. Smoking was not part of this score, but we did correct for that. After all, we know that smoking increases the risk of cancer recurrence.’

Doing something yourself

Based on the healthy lifestyle score, the researchers created three groups. Did bladder cancer recur less often in the most healthy group? ‘Yes’, Van Zutphen replies. ‘We saw 26% lower risk of disease recurrence in the group that scored highest on a healthy lifestyle compared to the group with the least healthy lifestyle. In addition, a healthier lifestyle was found to be associated with better quality of life.’

Currently, patients barely receive lifestyle advice when diagnosed with bladder cancer. ‘At most, the urologist advises quitting smoking and drinking lots of fluids’, Vrieling explains. ‘While many people after a cancer diagnosis ask their doctor what they can do themselves. In our study, we see a positive effect of an overall healthy lifestyle. We need more studies that confirm our findings before we can give sufficient evidence-based advice. But living a little healthier is always a good idea.’

About the publications

The results of this study have been published:
-    In the American Journal for Clinical Nutrition: Adherence to lifestyle recommendations after non-muscle invasive bladder cancer diagnosis and risk of recurrence. Moniek van Zutphen, Jasper P Hof, Katja KH Aben, Ellen Kampman, J Alfred Witjes, Lambertus ALM Kiemeney, Alina Vrieling.
-    In the International Journal of Cancer: Longitudinal associations of adherence to lifestyle recommendations and health-related quality of life in patients with non-muscle invasive bladder cancer. Short title: Lifestyle and quality of life after NMIBC. Nikoletta Vidra, Ivy Beeren, Moniek van Zutphen, Katja K. Aben, Ellen Kampman, J. Alfred Witjes, Antoine G. van der Heijden, Lambertus A. Kiemeney and Alina Vrieling.

This study was conducted with funding from KWF and World Cancer Research Fund.

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