Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are no sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors. In the present study we used the validated Italian version of QLQ-BLM30 to assess bladder cancer-specific HRQOL in patients with ileal orthotopic neobladder (IONB) after RC. Patients and Methods: From June 2007 to September 2012, a total of 171 consecutive patients with bladder cancer (156 males and 15 females), who underwent RC with IONB in five urological academic centres, were included in this study. All patients had no evidence of tumor recurrence and were actively followed-up. Clinical and pathological data as well as clinical outcomes were retrospectively analyzed. HRQOL was analyzed using Italian versions of the EORTC BLM30 questionnaires. Questionnaire results were analyzed in order to evaluate the HRQOL in patients with IONB at different times of follow-up (1-18, 19-36, 37-72 and ≥73 months). Mean values with standard deviations (±SD) were computed for all items. Wilcoxon rank test was used to verify differences by comparing the short follow-up (1-18 months, first quartile) with subsequent quartiles of follow-up. Statistical significance was achieved if p -value was ≤0.05. Results: The median age of the patients was 66 years. The pTNM–UICC stages were 36.8% (0-I), 46.2% (II), and 17.0% (III-IV stage). 17 (9.9%) patients underwent adjuvant chemotherapy. The median of follow-up was 38 months. The number of patients for each quartile of follow-up were: 43, 42, 35, and 51, respectively for 1-18, 19- 36, 37-72, and ≥73 months. Our data showed that patients with a long-term follow-up (≥73 months) had an improvement in HRQOL in urinary symptoms in comparison with patients with short-term follow-up (1-18 months) (34.1±23.6 vs . 18.9±21.1 - p= 0.0004) as well as in sexual life (96.9±8.5 vs. 83.7±25.2 - p= 0.005). Conversely we found a worse HRQOL in patients with long-term follow-up regarding the abdominal bloating and flatulence (8.9±22.2 vs . 17.6±20.9 - p= 0.003). In addition in patients with an intermediate follow-up (37-72 months) we found a poor HRQOL in body image (23.8±27.6 vs. 35.6±27.5 - p= 0.02), and sexual functioning (13.8±23.8 vs. 21.9±24.5 - p= 0.04). Discussion and Conclusion: The patients with IONB show a progressive decrease of limitations of HRQOL during the years demonstrating a high adaptability to the new body image. Our study based on long-term follow-up in patients undergoing RC with IONB showed improvement in HRQOL with regards to the role of urinary symptoms and sexual life.
QUALITY OF LIFE IN 171 PATIENTS WITH BLADDER CANCER UNDERGOING ILEAL ORTHOTOPIC NEOBLADDER: LONG-TERM RESULTS
LONARDI, Cristina;CERRUTO, Maria Angela;
2014-01-01
Abstract
Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are no sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors. In the present study we used the validated Italian version of QLQ-BLM30 to assess bladder cancer-specific HRQOL in patients with ileal orthotopic neobladder (IONB) after RC. Patients and Methods: From June 2007 to September 2012, a total of 171 consecutive patients with bladder cancer (156 males and 15 females), who underwent RC with IONB in five urological academic centres, were included in this study. All patients had no evidence of tumor recurrence and were actively followed-up. Clinical and pathological data as well as clinical outcomes were retrospectively analyzed. HRQOL was analyzed using Italian versions of the EORTC BLM30 questionnaires. Questionnaire results were analyzed in order to evaluate the HRQOL in patients with IONB at different times of follow-up (1-18, 19-36, 37-72 and ≥73 months). Mean values with standard deviations (±SD) were computed for all items. Wilcoxon rank test was used to verify differences by comparing the short follow-up (1-18 months, first quartile) with subsequent quartiles of follow-up. Statistical significance was achieved if p -value was ≤0.05. Results: The median age of the patients was 66 years. The pTNM–UICC stages were 36.8% (0-I), 46.2% (II), and 17.0% (III-IV stage). 17 (9.9%) patients underwent adjuvant chemotherapy. The median of follow-up was 38 months. The number of patients for each quartile of follow-up were: 43, 42, 35, and 51, respectively for 1-18, 19- 36, 37-72, and ≥73 months. Our data showed that patients with a long-term follow-up (≥73 months) had an improvement in HRQOL in urinary symptoms in comparison with patients with short-term follow-up (1-18 months) (34.1±23.6 vs . 18.9±21.1 - p= 0.0004) as well as in sexual life (96.9±8.5 vs. 83.7±25.2 - p= 0.005). Conversely we found a worse HRQOL in patients with long-term follow-up regarding the abdominal bloating and flatulence (8.9±22.2 vs . 17.6±20.9 - p= 0.003). In addition in patients with an intermediate follow-up (37-72 months) we found a poor HRQOL in body image (23.8±27.6 vs. 35.6±27.5 - p= 0.02), and sexual functioning (13.8±23.8 vs. 21.9±24.5 - p= 0.04). Discussion and Conclusion: The patients with IONB show a progressive decrease of limitations of HRQOL during the years demonstrating a high adaptability to the new body image. Our study based on long-term follow-up in patients undergoing RC with IONB showed improvement in HRQOL with regards to the role of urinary symptoms and sexual life.
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