New findings provide strong evidence that radical cystectomy (RC), when performed at a high-volume center, does not result in substantial declines in patient-reported health-related quality of life (HRQoL) within the first 2 years after surgery following the initial post-RC recovery period, according to investigators.
Bernard H. Bochner, MD, of Memorial Sloan Kettering Cancer Center in New York, New York, and colleagues examined responses to 14 HRQoL questionnaires from 411 patients undergoing RC for high-risk bladder cancer both before and after surgery. Instruments included the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire, the Female Sexual Functioning Index, IIEF, and other validated tools.
Open surgery was performed in 88% of the cohort. A total of 205 patients had an ileal conduit constructed and 206 received continent diversion.
At baseline, the continent diversion group reported significantly better mean physical, urinary, and sexual function compared with the ileal conduit group, but significantly lower social function. Patients receiving continent diversions were on average 10 years younger, employed, and had better renal function. The ileal conduit group had higher rates of variant histologies, intravesical therapy, and prior pelvic surgery or radiation.
Global quality of life exceeded baseline scores in both groups within 6 months of surgery, Dr Bochner and colleagues reported in European Urology. Physical function scores decreased by 5% within 6 months of surgery, but stabilized or returned to baseline levels by 24 months.
By 12 months, social function improved by 10% in the continent diversion group, whereas it remained stable in the ileal conduit group.
Sexual function scores were low before RC, with limited recovery after surgery.
Scores in psychosocial domains remained stable or improved, except for a 10% worsening of body image among patients with an ileal conduit.
“These data should be incorporated into preoperative RC counseling to lessen the uncertainty associated with life after surgery,” the investigators wrote. “Furthermore, these contemporary surgical outcomes will be useful for comparative evaluations of HRQOL related to future bladder preservation strategies.”
Clements MB, Atkinson TM, Dalbagni GM, et al. Health-related quality of life for patients undergoing radical cystectomy: results of a large prospective cohort. Eur Urol. Published online October 8, 2021. doi:10.1016/j.eururo.2021.09.018