Outcomes of a Dietary Intervention to Reduce Bladder Cancer Recurrence and Progression in Survivors of Non–Muscle-Invasive Bladder Cancer

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Karen H. Kim Yeary Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Han Yu Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Margaret Gates Kuliszewski New York State Cancer Registry, Albany, NY

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Qiang Li Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Susan E. McCann Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Rachel Pratt Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Frances G. Saad-Harfouche Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Zinian Wang Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Nikia Clark Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Chong Wang Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Elizabeth DiCarlo Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Li Tang Roswell Park Comprehensive Cancer Center, Buffalo, NY

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Background: As one of the 10 most common cancers in the United States, bladder cancer is the most expensive cancer to treat. Most bladder cancers (70%–80%) are diagnosed at early stages as non–muscle-invasive bladder cancer (NMIBC), which can be removed. However, 50% to 80% of NMIBC recurs within 5 years, and 15% to 30% progresses with poor survival. Besides life-long surveillance, current treatment is limited. Preclinical and epidemiologic evidence suggest that dietary isothiocyanates (ITCs) in cruciferous vegetables (Cruciferae) could be a noninvasive and cost-effective strategy to improve NMIBC prognosis. Yet, a Cruciferae intervention that increases ITC exposure in NMIBC survivors has not been tested. Thus, the primary aim of this study was to test the effect of a Cruciferae intervention on urinary ITC levels and Cruciferae intake in NMIBC survivors. Patients and Methods: We conducted a 2-arm, double-blinded, randomized controlled trial to test the efficacy of a Cruciferae intervention against a general fruit and vegetable intervention (control) for NMIBC survivors. Both 6-month interventions consisted of mailed educational materials, a live call with staff to review the materials, and 11 interactive voice response calls. We anticipated that our Cruciferae intervention (Power to Redefine Your Health [POW-R Health]) would increase Cruciferae intake to 1 cup/day (secondary outcome), thus raising urinary ITC levels to 10 µM (primary outcome) from baseline to 6-month follow-up. Results: We randomized 49 patients with NMIBC diagnosed in 2018 through 2019, and retained 42 patients at 6-month follow-up. The treatment group reported 0.94 cups (95% CI, 0.24–1.65; P=.010) higher Cruciferae intake (treatment, 1.37 ± 1.19 cups vs control, 0.56 ± 0.72 cups) and increased urinary ITC levels by 11.1 μmol/g creatinine (treatment, 26.2 ± 20.9 vs control, 7.8 ± 11.5; P=.027) at 6-month follow-up compared with the control group. Conclusions: Our dietary intervention is the first to significantly increase Cruciferae intake and urinary ITC levels in NMIBC survivors, demonstrating an increase in ITC to levels that significantly decrease risk of disease-specific survival. A future randomized controlled trial testing POW-R Health on bladder cancer recurrence and progression is warranted. If proven to improve bladder cancer outcomes, our intervention has the potential to be a noninvasive, cost-effective, easily accessible way for NBMIC survivors to improve their bladder cancer prognosis.

Submitted April 12, 2023; final revision received August 17, 2023; accepted for publication September 12, 2023. Published online February 26, 2024.

Author contributions: Conceptualization: Yeary, Clark, Tang. Data curation: Saad-Harfouche, DiCarlo. Statistical analysis: Yu, C. Wang. Investigation: McCann, Pratt, Z. Wang. Resources: Kuliszewski, Li. Writing—original draft: Yeary. Writing—review and editing: Kuliszewski, Li, Saad-Harfouche, Clark, DiCarlo, Tang.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number R21 CA253910-01 (K.H.K. Yeary) and Roswell Park Comprehensive Cancer Center Grant P30CA016056 from the National Cancer Institute.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Karen H. Kim Yeary, PhD, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. Email: karen.yeary@Roswellpark.org
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