Threading the Needle in Bladder Cancer: A Narrative Review of the Emerging Role of Integrative Oncology in Treatment-Related Adverse Events in the Era of Immunotherapy and Antibody-Drug Conjugates.

Bladder cancer is a common malignancy with substantial morbidity, and recent advances in immune checkpoint inhibitors, antibody-drug conjugates, and targeted therapies have improved outcomes across disease stages. Despite these gains, emerging therapies are associated with substantial treatment-related adverse events (TRAEs), including neuropathy, rash, gastrointestinal, ocular, and immune-mediated toxicities, often leading to dose reductions or therapy discontinuation. In this review, we aim to examine the landscape of integrative oncology, its areas of efficacy and uncertainty, and how these therapies may mitigate TRAEs in bladder cancer survivors. Integrative oncology provides patient-centered, evidence-informed approaches to alleviate TRAEs and enhance quality of life. Evidence from randomized trials and systematic reviews suggests that a range of integrative oncology interventions, including acupuncture, cryotherapy, and mind-body therapies, may help temper treatment-related symptoms and improve quality of life among cancer survivors. Nutritional and lifestyle interventions may offer additional benefits, although evidence regarding their safety and optimal implementation remains limited. While most supporting evidence derives from non-genitourinary malignancies, important differences in treatment regimens, patient characteristics, and toxicity profiles limit direct extrapolation to bladder cancer populations, despite overlap in key symptom domains such as fatigue, pain, and peripheral neuropathy. Prospective, disease-specific research is needed to define best practices and integrate multidisciplinary supportive care with conventional therapies. Thoughtful incorporation of integrative oncology may help "thread the needle" between treatment intensity and patient-centered care, with the potential to enhance adherence, survivorship, and the overall patient experience.