Prospective Health-related Quality of Life Analysis for Patients Undergoing Radical Cystectomy and Urinary Diversion - 26/09/14

Doi : 10.1016/j.urology.2014.05.046

Michael C. Large ^a,^b, Rena Malik ^a, Joshua A. Cohn ^a, Kyle A. Richards ^a,^⁎ , Cory Ganshert ^a, Rangesh Kunnavakkum ^c, Norm D. Smith ^a, Gary D. Steinberg ^a
^a Department of Surgery, Section of Urology, The University of Chicago Medical Center, Chicago, IL
^b Urology of Indiana, Greenwood, IN
^c Department of Statistics, The University of Chicago Medical Center, Chicago, IL

^∗Reprint requests: Kyle A. Richards, M.D., Department of Surgery, Section of Urology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6038 Chicago, IL 60637.

Abstract

Objective

To better define health-related quality of life (HRQOL) for patients undergoing radical cystectomy (RC) and urinary diversion.

Materials and Methods

Patients undergoing RC and urinary diversion for urothelial carcinoma by 1 of 2 surgeons (G.D.S. or N.D.S.) had a HRQOL assessment at baseline and at follow-up using the validated, bladder cancer–specific Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index questionnaire. The primary outcome was change in HRQOL between baseline and follow-up.

Results

From September 15, 2011, to July 23, 2012, 74 of 103 eligible patients were enrolled, and all but 1 completed the baseline Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index leaving 73 patients in the study. Median age was 68 years (interquartile range, 60-74 years), 58 (78%) were Caucasian, 53 (73%) were ≥cT2, 45 (62%) underwent incontinent diversion, and the mean age-adjusted Charlson Comorbidity Index score was 2.4 ± 1.8, with no significant differences among the 73 participants and 30 nonparticipants. The median time from surgery to response was 175 days (interquartile range, 102-232 days), and the response rate was 67%, with 9 deaths during follow-up. Baseline HRQOL scores did not significantly differ between respondents and nonrespondents or between those living vs deceased. Overall, RC-specific, physical, social, and functional HRQOL scores did not differ from baseline to follow-up, whereas emotional HRQOL scores were significantly improved (15.7 ± 5.8 vs 18.1 ± 3.9, P = .03). Overall or domain-specific HRQOL measures did not differ significantly between patients undergoing incontinent (n = 27) vs continent (n = 16) diversions.

Conclusion

Overall, HRQOL scores did not statistically differ from baseline to the median 6-month follow-up for patients undergoing RC and urinary diversion for urothelial carcinoma. Patients undergoing continent vs incontinent urinary diversions had similar overall HRQOL scores at follow-up.

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