Health-related Quality of Life for Patients Undergoing Radical Cystectomy: Results of a Large Prospective Cohort

被引:66
作者
Clements, Matthew B. [1 ]
Atkinson, Thomas M. [2 ]
Dalbagni, Guido M. [1 ]
Li, Yuelin [2 ]
Vickers, Andrew J. [3 ]
Herr, Harry W. [1 ]
Donat, S. Machele [1 ]
Sandhu, Jaspreet S. [1 ]
Sjoberg, Daniel S. [3 ]
Tin, Amy L. [3 ]
Rapkin, Bruce D. [4 ]
Bochner, Bernard H. [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY 10065 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Psychiat & Behav Sci, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10065 USA
[4] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, Bronx, NY 10467 USA
关键词
Patient-reported outcomes; Radical cystectomy; Quality of life; Bladder cancer; ORTHOTOPIC NEOBLADDER; BLADDER-CANCER; ILEAL CONDUIT; INTERNATIONAL INDEX; ERECTILE FUNCTION; INSTRUMENT; RECONSTRUCTION; QUESTIONNAIRE; SATISFACTION; METAANALYSIS;
D O I
10.1016/j.eururo.2021.09.018
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:294 / 304
页数:11
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