Health-related quality of life for patients undergoing radical cystectomy: Results of a large prospective cohort Journal Article


Authors: Clements, M. B.; Atkinson, T. M.; Dalbagni, G. M.; Li, Y.; Vickers, A. J.; Herr, H. W.; Donat, S. M.; Sandhu, J. S.; Sjoberg, D. S.; Tin, A. L.; Rapkin, B. D.; Bochner, B. H.
Article Title: Health-related quality of life for patients undergoing radical cystectomy: Results of a large prospective cohort
Abstract: Background: Radical cystectomy (RC) has the potential for profound changes to health-related quality of life (HRQOL). Objective: To evaluate a broad range of HRQOL outcomes in a large RC cohort. Design, setting, and participants: A single-center prospective study enrolled RC patients from 2008 to 2014. We collected 14 separate patient-reported outcome measures at the presurgical visit and at 3, 6, 12, 18, and 24 mo after RC. Outcome measurements and statistical analysis: To visualize the patterns of recovery over time across domains, we used generalized estimating equations (GEES) with nonlinear terms. Given substantial differences in patient selection for the type of urinary diversion, we separately modeled longitudinal HRQOL within conduit and continent diversion groups. The mean pre-RC scores were compared to illustrate the baseline HRQOL differences between diversion groups. Results and limitations: The analyzed cohort included 411 patients (n = 205 ileal conduit, n = 206 continent diversion). At baseline, patients receiving continent diversion reported better mean physical (p < 0.001), urinary (p = 0.006), and sexual function (p < 0.001), but lower social function (p = 0.015). After RC, GEE modeling showed physical function scores decreasing 5/100 points by 6 mo, and subsequently stabilizing or returning to baseline. By 12 mo, social function improved by 10/100 points among continent diversions, while remaining stable among ileal conduits. Global quality of life exceeded baseline scores by 6 mo. Sexual function scores were low before RC, with limited recovery. Psychosocial domains were stable or improved, except for 10/100-point worsening of body image among ileal conduits. Conclusions: RC patients reported favorable HRQOL recovery within 24 mo in most areas other than body image (ileal conduits) and sexual function (both). Importantly, large measurable decreases in scores were not reported by 3 mo after RC. These contemporary outcomes and the excellent locoregional control provided by RC further support it as the gold standard therapy for high-risk bladder cancer. Patient summary: We review quality of life in the 24 mo following radical cystectomy. Large decreases in health-related quality of life were not reported, with most areas returning to, or exceeding, baseline, except for sexual function and body image. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords: quality of life; questionnaire; radical cystectomy; satisfaction; patient-reported outcomes; reconstruction; erectile function; bladder; bladder-cancer; metaanalysis; instrument; index; international; ileal conduit; cancer; orthotopic neobladder
Journal Title: European Urology
Volume: 81
Issue: 3
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2022-03-01
Start Page: 294
End Page: 304
Language: English
ACCESSION: WOS:000809752100021
DOI: 10.1016/j.eururo.2021.09.018
PROVIDER: wos
PMCID: PMC8891075
PUBMED: 34629182
Notes: Article -- Daniel Sjoberg's name lists the wrong middle initial on the original publication -- Source: Wos
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MSK Authors
  1. Yuelin Li
    219 Li
  2. Jaspreet Sandhu
    138 Sandhu
  3. Guido Dalbagni
    325 Dalbagni
  4. Sherri M Donat
    174 Donat
  5. Andrew J Vickers
    882 Vickers
  6. Thomas Michael Atkinson
    155 Atkinson
  7. Daniel D. Sjoberg
    234 Sjoberg
  8. Bernard Bochner
    468 Bochner
  9. Harry W Herr
    594 Herr
  10. Amy Lam Ling Tin
    114 Tin