Does following our Cancer Prevention Recommendations benefit bladder cancer survivors?

Adherence to WCRF/AICR’s lifestyle Recommendations in bladder cancer patients: associations with risk of recurrence and health-related quality of life

  • Topic: Bladder cancer
  • Institution: Radboud University Medical Center
  • Country: Netherlands
  • Status: Ongoing

"There is a lack of good quality evidence on the role of diet, nutrition and physical activity in clinical outcomes of cancer survivors. With WCRF’s support, we can investigate whether adhering to the Cancer Prevention Recommendations has a beneficial impact on risk of recurrence and quality of life in patients diagnosed with bladder cancer"

– Dr Alina Vrieling


Patients diagnosed with non-muscle invasive bladder cancer (NMIBC) are at a high risk of cancer recurrence. After diagnosis, they are subjected to a burdensome follow-up programme which may have a great impact on their quality of life. Many NMIBC patients ask their urologists whether making healthy lifestyle changes can reduce their risk of recurrence and improve their quality of life. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) advises cancer survivors to follow their Cancer Prevention Recommendations. However, it is currently unknown whether following these Recommendations is beneficial for NMIBC patients. There is some evidence that NMIBC patients who smoke or have excess body weight at diagnosis are at an increased risk of recurrence. Bladder cancer patients who are physically active have been shown to have a better quality of life. However, this evidence is based on a small number of studies of relatively low quality. It has not been previously investigated whether following WCRF/AICR’s lifestyle Recommendations is related to a reduced risk of recurrence and a better quality of life in NMIBC patients.

Aims and objectives

The objective of this project is to investigate whether NMIBC patients who better follow WCRF/AICR’s lifestyle Recommendations have a reduced risk of recurrence and a better quality of life. We will evaluate overall adherence as well as adherence to seven individual recommendations concerning:

  1. body fatness
  2. physical activity
  3. consumption of foods and drinks that promote weight gain
  4. plant food intake
  5. red and processed meat intake
  6. alcohol consumption
  7. use of dietary supplements

How it will be done

This proposed project will be carried out using data from the ongoing prospective multicentre cohort study, UroLife, which was initiated in 2014 to investigate the effect of dietary and lifestyle habits on prognosis and quality of life in NMIBC patients. From 2014–17, 1,100 newly diagnosed NMIBC patients from 22 hospitals in the Netherlands were included (response rate 52 per cent). At six weeks, three months, and 15 months after diagnosis, patients completed self-administered questionnaires including questions on smoking, physical activity, alcohol consumption, dietary supplement use, and body weight. Dietary habits were assessed using validated food frequency questionnaires. Data on sociodemographic characteristics, comorbidity and medication use were also collected. Quality of life was assessed using a validated questionnaire. In January 2021, clinical data and follow-up data (including tumour characteristics, therapy, and recurrence) will be collected by the Netherlands Cancer Registry. Statistical analyses will be conducted to evaluate the association of adherence to WCRF/AICR’s lifestyle Recommendations with risk of recurrence and with quality of life.

Potential impact

This project will be the first to provide insight into whether following WCRF/AICR’s lifestyle Recommendations is related to a reduced risk of recurrence and better quality of life in NMIBC patients.