Long-term quality of life in patients with bladder cancer following radical cystectomy

Abstract

Objectives: To investigate changes in quality of life (QoL) up to 8 years after radical cystectomy (RC) and compare QoL after RC with a gender- and age-matched Dutch normative population. Furthermore, we aimed to identify patient characteristics associated with QoL and QoL trajectories after RC. Patients and Methods: Patients with bladder cancer were invited to complete QoL questionnaires at 3-month intervals in the first year and yearly thereafter. Follow-up data were available for a maximum of 8 years. We used linear mixed-effect models to investigate changes in QoL subscales (physical functioning [PF], emotional functioning [EF], and QoL summary score [QoL-sum]) over time, and to identify potential demographic and clinical correlates of QoL and QoL trajectories (i.e., interaction with time). Results: Data from 278 patients was included. Post-RC EF scores increased from 83.7 (95% confidence interval [CI] 81.7–85.6) to levels comparable to the normative population (90.1) 8 years after RC. PF (post-RC: 82.4, 95% CI 78.5–86.3) and QoL-sum (post-RC: 88.2, 95% CI 85.2–91.2) remained lower compared to the normative population (88.9 and 91.4, respectively) 8 years after RC. Compared to patients with an American Society of Anesthesiologists (ASA) score of 1 at diagnosis, those with ASA score 2 or ASA score 3 had significant lower post-RC PF (mean difference (MD) = −8 and −22, respectively; P < 0.001), EF (MD = −1 and −11; P = 0.5 and P < 0.01) and QoL-sum (MD = −2 and −9; P = 0.2 and P < 0.01). In addition, patients with a higher ASA score had a worse QoL-sum trajectory (Pinteraction = 0.01). Older patients had a worse PF trajectory (Pinteraction < 0.01) but higher post-RC EF (P < 0.01). Conclusions: Directly after RC, patients have lower PF, EF and QoL-sum, compared to a normative population. Notably, EF recovers to normative levels over a period of 8 years after RC. Clinicians are encouraged to administer supportive care interventions to enhance the QoL for patients undergoing RC, especially targeting older patients and those with higher ASA scores.