Association of dietary practice, rather than knowledge or attitude, with health-related quality of life in elderly NMIBC survivors: a cross-sectional study.

BACKGROUND: Health-related quality of life (HRQoL) is a critical concern in elderly non-muscle-invasive bladder cancer (NMIBC) survivors, but modifiable dietary factors remain underexplored. Using a cross sectional design, this study aimed to investigate the association between dietary knowledge-attitude-practice (KAP) scores and HRQoL in recurrence-free elderly NMIBC patients 12 months after TURBT, and to identify which KAP dimension shows the strongest independent association. METHODS: We enrolled 106 patients (aged ≥60 years) recurrence-free at 12 months post-TURBT who completed intravesical therapy. Dietary KAP was assessed using a culturally adapted questionnaire, analyzed both continuously and dichotomized at the median (42) for descriptive purposes. HRQoL was measured with the FACT-Bl total and Trial Outcome Index (TOI). Multivariable linear regression adjusted for age, sex, education, smoking, tumor stage, and therapy type. RESULTS: The High-KAP group (n = 53) had significantly higher FACT-Bl total (115.4 vs. 94.2) and TOI (84.1 vs. 68.5, both p < 0.001) as compared with Low-KAP group. In continuous analyses, each 1-point KAP increase was associated with a 0.58-point higher FACT-Bl (95% CI: 0.42-0.74) and 0.62-point higher TOI (0.48-0.76). Among subdomains, only practice remained significant (β = 1.24 and 1.31, both p < 0.001); while knowledge and attitude were not. CONCLUSION: Higher dietary KAP strongly is associated with better HRQoL, and this association appears primarily attributable to actual practice, not knowledge or attitude. These findings support behavior-focused, culturally tailored dietary support in survivorship care, although causality cannot be inferred due to the cross sectional design.