How can I effectively manage the side effects of treatment in patients undergoing therapy for bladder cancer?

Effective management of side effects in patients undergoing therapy for bladder cancer involves regular clinical and radiological monitoring to detect and address treatment-related toxicity promptly. For those receiving first-line or second-line chemotherapy, active symptom management is essential, and treatment should be stopped if excessive toxicity or disease progression occurs. Specialist urology multidisciplinary teams should be involved in managing bladder toxicity symptoms after radiotherapy, especially if symptoms are not controlled by antispasmodics or non-opiate analgesia and other causes have been excluded by cystoscopy. For symptoms such as haematuria, dysuria, urinary frequency, or nocturia caused by advanced bladder cancer, palliative hypofractionated radiotherapy can be offered to relieve symptoms. In cases of intractable bleeding, hypofractionated radiotherapy or embolisation may be considered, with specialist team input if these are unsuitable. Pelvic pain management may include hypofractionated radiotherapy, nerve blocks, or palliative chemotherapy alongside best supportive care. Additionally, patients undergoing radical cystectomy should have access to stoma care nurses and clinical nurse specialists to manage urinary diversion-related issues. Referral to specialist palliative care teams should be considered for symptom control and holistic support in incurable cases. Overall, multidisciplinary team involvement and individualized symptom management are key to effectively managing side effects of bladder cancer treatment.

Key points:

• Regular monitoring and active management of treatment toxicity during chemotherapy.
• Specialist input for bladder toxicity symptoms post-radiotherapy.
• Palliative radiotherapy for symptom relief in advanced disease.
• Management options for intractable bleeding and pelvic pain.
• Support from stoma care and specialist nurses after radical cystectomy.
• Referral to specialist palliative care for holistic symptom management.

These approaches align with NICE guidelines on bladder cancer diagnosis and management ¹.