Division of Urology
University of Ottawa
Impaired emotional, physical and social well-being in radical cystectomy patients
Julie G Trudel1, Conrad Maciejewski2.
1The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; 2Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada
Introduction: Radical cystectomy (RC) can have a negative impact on the patients emotional, physical and social well-being along the illness trajectory. There is a paucity of studies examining the Health-related Quality of life (HRQOL) of bladder cancer patients before RC. This study evaluated the HRQOL of RC patients before and after surgery.
Methods: RC patients were enrolled in the Diana Wood Cancer Survivorship Clinic at the Ottawa Hospital from January 2019. Questionnaires were completed prior to and 2-3 months post RC. Validated HRQOL instruments were used: FACT-Bl, SF-36 and Distress Thermometer (DT). Wilcoxon matched-pairs signed Rank Tests were performed to determine changes in HRQOL scores.
Results: 54 RC patients completed HRQOL measures before and after RC. Mean age was 67 years (SD: 9.7 years); 67% were men, 61% underwent an ileal conduit diversion. Clinically significant pre-post differences were seen in medians for four SF-36 scale scores. Lower post-cystectomy scores were obtained in: Physical Functioning” (p=0.00), “Role limitations due to Physical Health” (p=0.00), “Energy/Fatigue” (p=0.01) and “Social Well-Being” (p=0.02). Clinically significant differences were also found for DT scores. Patients exhibited more emotional distress before RC (p=0.005) and more physical concerns after RC (p=0.007). FACT-Bl results correspond with those obtained with SF-36 and DT. Moreover, after RC, younger patients (<65 years) were less content with their social life and the older ones (>=65 years) exhibited more fatigue. Neo-bladder patients cited more physical problems after RC including urinary, sexual, gastro-intestinal concerns and fatigue.
Conclusions: Emotional distress is often reported before RC and physical concerns are frequently identified after RC. Older patients and neo-bladder diversions encountered more physical problems after RC. Cancer survivorship needs in RC patients must be tailored to patients age and urinary diversion to optimize HRQOL outcomes.
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