[Assessment of QOL and survival for patients undergoing radical cystectomy or bladder preservation for invasive bladder cancer]

Impact of invasive bladder cancer and orthotopic urinary diversion on general health-related quality of life: An SF-36 survey

Bladder cancer is a common type of genitourinary cancer, and radical cystectomy with urinary diversion is considered to be the most effective local treatment for invasive bladder cancer. In order to assess the functional results and health-related quality of life (QOL) in bladder cancer patients with an orthotopic neobladder, and to provide a reasonable basis for the evaluation of urinary diversion in situ, we conducted a study on 96 neobladder patients. In December, 2011, questionnaires were mailed to 96 patients that had undergone urinary diversion surgery between January, 2007 and December, 2009. The questionnaire included the validated health-related QOL questionnaire and the MOS 36-item Short-Form Health Survey (SF-36). We compared the functional results between patients with an orthotopic neobladder and those with other types of urinary diversion at 6, 12 and 24 months after surgery. Data from 82 patients (54 with orthotopic and 28 with non-orthotopic urinary diversion) were included in the analysis. The SF-36 patient scores following orthotopic urinary diversion were significantly higher than those following non-orthotopic urinary diversion. The majority of patients with orthotopic urinary diversion considered themselves as healthy and their scores of total health were higher compared to those of patients with non-orthotopic urinary diversion. However, there were no differences in the scores of physical functioning between patients with orthotopic and those with non-orthotopic urinary diversion. Our findings regarding health-related QOL and the frequency of complications in the orthotopic and the non-orthotopic urinary diversion groups were similar. However, the mental health of patients with orthotopic urinary diversion was more easily restored compared to that of patients with non-orthotopic urinary diversion, which reduced their overall recovery time.

Prospective quality-of-life assessment in patients receiving concurrent gemcitabine and radiotherapy as a bladder preservation strategy

OBJECTIVES

To assess, in a Phase I study, whether bladder preservation with concurrent gemcitabine and radiotherapy (RT) influenced patient-reported quality of life (QOL) as determined by the Functional Assessment of Cancer Therapy-Bladder (FACT-BL).

METHODS

Between January 1998 and March 2002, 24 patients with urothelial carcinoma of the bladder were enrolled, and 23 patients underwent transuretheral resection of bladder tumor, followed by twice-weekly gemcitabine with concurrent RT. The initial dose was 10 mg/m2 given twice weekly and increased as tolerated. To assess treatment-related QOL, patients completed the FACT-BL questionnaire.

RESULTS

Of the 24 patients enrolled, 23 (96%) were assessed for toxicity and response. The FACT-generic (G) QOL assessment was obtained from 22 (92%) of 23 patients. No statistically significant difference was found in the FACT-G or FACT-BL or the combination before, during, or after treatment. The FACT-BL values were lower in patients who received higher doses of gemcitabine (greater than 20 mg/m2 versus 20 mg/m2 or less). At least one dose-limiting toxicity (DLT) was experienced by 5 (23%) of 22 patients. The FACT-G values were lower for those patients who experienced DLT (difference of -13.1, P = 0.07). The physical well-being scores for patients who experienced DLT were lower after treatment (difference of -5.2, P = 0.03) compared with those without DLT.

CONCLUSIONS

Concurrent RT and gemcitabine failed to statistically influence patient-reported QOL, although patients who received higher doses reported lower FACT-BL scores. The results of this study suggest that concurrent gemcitabine with conformal RT is a tolerable treatment regimen for bladder preservation, as demonstrated by the excellent treatment compliance and similar FACT measurements.