Patients with bladder cancer reported improvements in physical and social scores following radical cystectomy, although body image and sexual functioning scores decreased.
Patients with bladder cancer who underwent radical cystectomy reported that their health-related quality of life (HRQOL) recovered within 24 months of their procedure across most areas with the exception of body image and sexual function, according to a study (NCT00745355) published in European Association of Urology.
Patients who received continent diversion reported better physical (P <.001), urinary (P = .006), and sexual function (P<.001), but also reported lower social function (P = .015) at baseline. After undergoing radical cystectomy, physical scores at 6 months decreased by 5/100 points before subsequently stabilizing and returning to baseline levels. Social functions at 12 months improved by 10/100 points for patients with continent diversions and remained stable for ileal conduits. Patients’ sexual function scores were low prior to radical cystectomy and had limited recovery following the procedure.
“This study provides a comprehensive, 2-year longitudinal evaluation of contemporary [patient reported outcomes] PROs following [radical cystectomy] RC and urinary diversion. Although we observed decreases in some domains capturing physical health up to 6 months postoperatively, by 24 months HRQOL returned to or exceeded baseline in all domains other than sexual function,” investigators of the study wrote.
The prospective study included a cohort of 411 patients who underwent radical cystectomy with 205 patients receiving an ileal conduit and 206 undergoing continent diversion. A total of 88% of patients were treated with an open surgical approach. Prior to surgery, 71% of patients completed surveys and 48% completed a follow-up survey at 24 months.
Those who received continent diversions were an average of 10 years younger, had a higher preoperative estimated glomerular filtration rate, and were more likely to be men and employed. Those who were given an ileal conduit had higher rates of variant histologies, pretreatment with intravascular therapy, and prior pelvic surgery or radiation.
The European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire that was utilized for the study highlighted a higher baseline of physical functioning domain scores in the continent diversion group than the ileal conduit group with a mean difference of 6.1 (95% CI, 3.3-9.0; P <.001). Patients in the ileal conduit group had higher baseline scores for social functioning vs the continent diversion group, with a mean difference of 7.3 (95% CI, 1.4-13.1; P= .015).
The instruments assessing urinary function identified worse pre-radical cystectomy scores for those who received an ileal conduit. The Incontinence Impact Questionnaire highlighted a mean difference of 4.8 (95% CI, 0.1-9.4; P = .046), 7.9 for the Urogenital Distress Inventory (95% CI, 2.9-12.8; P = .002), and 6.7 for the EORTC urinary symptoms domain (95% CI, 1.9-11.4; P = .006).
Patients who received a continent diversion had higher baseline scores identified on the International Index of Erectile Function and overall satisfaction domains, with mean differences of 5.5 (95% CI, 2.4-8.5; P <.001), and 0.9 (95% CI, 0.1-1.7; P = .023), respectively. Investigators did not note any significant differences on the Female Sexual Function Index, with a full scale mean difference of 3.2 (95% CI, -5.6 to 12.0; P = .05).
In the continent diversion cohort EORTC QLQ-C30 Global QOL domain scores were similar to the baseline score (74) at 3 months, which improved to 80 at 12 months. In the ileal conduit group, patients had a score at 3 months that was similar to the baseline score; the score increased by 3 points at 24 months.
Patients physical functioning domain decreased by 5 points in the ileal conduit cohort at 3 months and returned to 94 points at 12 months. The same cohort experienced a decrease of 5 points at 3 months in the physical functioning domain, which included mobility and activities, and returned to preoperative levels by 12 months at 94 points. Additionally, patients in the ileal conduit group were close to their baseline score for role functioning at 24 months, and those with continent diversion had improved beyond their baseline scores.
Patients in the continent diversion group did not have any social functioning mean decreases from baseline, with scores increasing by 10 points at 12 months. Patients in the ileal conduit group had a mean decrease from 81 to 77 at 6 months, and it improved to 80 points at 24 months.
Within the ileal conduit cohort, Urinary Symptom domain scores had decreased by 4 points at 3 months, and then improved to 5 points below the baseline score. Patients in the ileal conduit group had a Urostomy domain score of 18 at 3 months following surgery, which improved to 13 points by 24 months.
Sexual function for patients in the ileal conduit cohort decreased from 37 to 27 points at 6 months, with little improvement by 24 months. Patients in the continent diversion group who had vaginal or nerve sparing radical cystectomy had scores decrease from 48 at baseline to 28 by 6 months, with a score of 36 at 12 months.
Clements MB, Atkinson TM, Dalbagni GM, et al. Health-related quality of life for patients undergoing radical cystectomy: results of a large prospective. Eur Urol. Published Online October 8, 2021. doi:10.1016/j.eururo.2021.09.018