INTRODUCTION AND AIM OF THE STUDY Bladder Cancer (BC) is the most common malignancy of the urinary tract and the seventh most common cancer in men and the 17th in women [1]. In the literature, several surgical options of urinary diversion after RC have been described, from simply diverting the urine through a conduit to orthotopic reconstruction The number of elderly patients candidates for radical cystec- tomy (RC) as treatment for bladder cancer is now increasing. Although for younger patients orthotopic neobladder after RC has gained popularity, this type of diversion can be suitable for elderly adults with no additional morbidity compared with an ileal conduit. Sparse data have been published on the comparison of these two types of diversion in elderly patients focusing the attention on QoL. The aim of the study was to evaluate QoL in elderly patients with bladder cancer who received an orthotopic neobladder of an ileal conduit after radical cystectomy (RC). MATERIALS AND METHODS A cross-sectional study analyzing files from 77 patients aged 75 or older (median age 77), who had received an orthotopic neobladder (n. 26, group 1) or an ileal conduit (n. 51, group 2) after RC at 5 Italian institutions was performed. QoL was evaluated by using the Italian version of the European Organisation for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30), a 30- item questionnaire that incorporates five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea/vomiting), and a global health and quality-of-life scale [2] and QLQ muscle invasive bladder cancer module (QLQ-BLM). RESULTS Patient s’ group s were comparable except for gender (0.029), pT stage (0.022), and long term complications (0.005). The scores of all th e QLQ multi-item scales and single-item measures were comparable in the two groups except for the following domains in favor of group 1 pati ents: cognitive functioning (0.008), sleep (0.048), appetite loss (0.033), constipation (0.001), financial difficulties (0.043). Using the propensity score matching, pati ents with orthotopic neo- bladder showed better but not significant QOL scores for the domains of cognitive functioning (0.069) and financial difficult ies (0.065). INTERPRETATION OF RESULTS The results of our study suggest that an orthotopic neobladder in elderly male patients with a low pT stage without long-term complication rate can offer better scores for some aspects of QoL when comparing to ileal conduit CONCLUSIONS Orthotopic neobladder in elderly patients may offer a better quality of life aspects, when compared to ileal conduit

A COMPARATIVE MULTICENTER QUESTIONNAIRE SURVEY ON QUALITY OF LIFE IN ELDERLY PATIENTS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: A COMPARISON BETWEEN ORTHOTOPIC NEOBLADDER AND ILEAL CONDUIT

CERRUTO, Maria Angela;LONARDI, Cristina;
2015

Abstract

INTRODUCTION AND AIM OF THE STUDY Bladder Cancer (BC) is the most common malignancy of the urinary tract and the seventh most common cancer in men and the 17th in women [1]. In the literature, several surgical options of urinary diversion after RC have been described, from simply diverting the urine through a conduit to orthotopic reconstruction The number of elderly patients candidates for radical cystec- tomy (RC) as treatment for bladder cancer is now increasing. Although for younger patients orthotopic neobladder after RC has gained popularity, this type of diversion can be suitable for elderly adults with no additional morbidity compared with an ileal conduit. Sparse data have been published on the comparison of these two types of diversion in elderly patients focusing the attention on QoL. The aim of the study was to evaluate QoL in elderly patients with bladder cancer who received an orthotopic neobladder of an ileal conduit after radical cystectomy (RC). MATERIALS AND METHODS A cross-sectional study analyzing files from 77 patients aged 75 or older (median age 77), who had received an orthotopic neobladder (n. 26, group 1) or an ileal conduit (n. 51, group 2) after RC at 5 Italian institutions was performed. QoL was evaluated by using the Italian version of the European Organisation for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30), a 30- item questionnaire that incorporates five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea/vomiting), and a global health and quality-of-life scale [2] and QLQ muscle invasive bladder cancer module (QLQ-BLM). RESULTS Patient s’ group s were comparable except for gender (0.029), pT stage (0.022), and long term complications (0.005). The scores of all th e QLQ multi-item scales and single-item measures were comparable in the two groups except for the following domains in favor of group 1 pati ents: cognitive functioning (0.008), sleep (0.048), appetite loss (0.033), constipation (0.001), financial difficulties (0.043). Using the propensity score matching, pati ents with orthotopic neo- bladder showed better but not significant QOL scores for the domains of cognitive functioning (0.069) and financial difficult ies (0.065). INTERPRETATION OF RESULTS The results of our study suggest that an orthotopic neobladder in elderly male patients with a low pT stage without long-term complication rate can offer better scores for some aspects of QoL when comparing to ileal conduit CONCLUSIONS Orthotopic neobladder in elderly patients may offer a better quality of life aspects, when compared to ileal conduit
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11562/951736
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