Quality of life issues in bladder cancer patients following cystectomy and urinary diversion

HRQOL outcomes in bladder cancer patients undergoing cystectomy and urinary diversion are an important component in the critical assessment of bladder cancer treatment. To date, understanding of HRQOL in these patients remains poor. Although it is known that there are common factors that most likely affect HRQOL for all patients, it is unclear whether factors unique to a specific type of diversion impact HRQOL in a way that makes one type of diversion superior to another. Factors such as stoma maintenance, catheter use, urinary incontinence, body image, and sexual side effects are potentially different for each major type of diversion and most likely impact HRQOL, but a consistent advantage of one type of diversion over another has yet to be demonstrated. With slight changes in the approach to studying HRQOL outcomes, this question could be answered. Prospective study designs, appropriate adjustment for confounding factors, diverse patient populations, and the use of validated and disease-specific instruments would greatly enhance understanding of HRQOL in patients undergoing cystectomy for bladder cancer. By understating these issues more completely, patients could be counseled not only about their predicted surgical risks and survival but also about the impact their disease will have on their longer-term quality of survival. Patients will then be able to make a more fully informed decision on the most appropriate form of therapy for this serious life-altering disease.