Approximately 75% of patients who are newly diagnosed with bladder cancer present with non-muscle-invasive bladder cancer (NMIBC). NMIBC survivors have unique chronic burdens, including frequent recurrences, repeated surveillance cystoscopies and treatments, and the highest lifetime medical cost per person among all cancers. Hence, the aim of conducting this study was to (1) examine the prevalence of uncertainty, post-traumatic stress disorder symptoms (PTSS), and quality of life (QOL) in NMIBC survivors, (2) identify factors associated with uncertainty, PTSS, and QOL, and (3) explore the relationships among uncertainty, PTSS, and QOL.

This dissertation consists of three manuscripts. The first is a systematic review of the literature on QOL in NMIBC survivors. The second and third manuscripts comprise the findings from a population-based survey study in North Carolina. The data from 376 NMIBC survivors were used for the analysis. The NMIBC survivors had urinary and bowel symptoms, sexual problems, and worries about the future, regardless of time since diagnosis. The lower cancer stage at diagnosis was associated with better QOL in several domains, including global health status, physical functioning, role functioning, social functioning, fatigue, dyspnea, and financial difficulties. Male survivors had better sexual function and enjoyment than females, but also higher discomfort with sexual intimacy and more concerns about contaminating their partners. The cystectomy group had worse sexual function, more discomfort with sexual intimacy, lower sexual enjoyment, and more male sexual problems than the non-cystectomy group. The NMIBC survivors had notable burdens of cancer-related uncertainty, and higher uncertainty was associated with males, lower income, the lack of cure, lower cognition-ability, and higher cognition-general concerns. The prevalence of PTSS (28.7 %) was higher than in the general United States (US) adult population (10-20%). Higher PTSS were associated with younger age, lack of cure, more comorbidities, less social support, and more cognition-general concerns. Uncertainty was significantly and negatively associated with QOL, and PTSS completely mediated the effect of uncertainty on QOL.

The findings of this dissertation highlight the importance of assessment and management of uncertainty and PTSS in the NMIBC population. Further studies are needed to better understand NMIBC survivors' unique needs and to develop supportive care interventions for them.