Health-Related Quality of Life after Radical Cystectomy for Bladder Cancer in Elderly Patients with Ileal Orthotopic Neobladder or Ileal Conduit: Results from a Multicentre Cross-Sectional Study Using Validated Questionnaires

Abstract

Objective: To evaluate health-related quality of life (HR-QoL) outcomes in elderly patients with different type of urinary diversion (UD), ileal conduit (IC) and ileal orthotopic neobladder (IONB), after radical cystectomy (RC) for bladder cancer, by using validated self-reported cancer-specific instruments. Patients and Methods: We retrospectively reviewed 77 patients who received an IC or an IONB after RC. HR-QoL was assessed with specific and validated disease questionnaires, administered at last follow-up. Result: At univariate analysis, at a mean follow-up of 60.91 ± 5.63 months, IONB results were favourable with regard to the following HR-QoL aspects: nausea and vomiting (p = 0.045), pain (p = 0.049), appetite loss (p = 0.03), constipation (p = 0.000), financial impact (p = 0.012) and cognitive functioning (p = 0.000). This last functional aspect was significantly worse in female patients (p = 0.029). Emotional functioning was significantly better in patients without long-term complications (p = 0.016). At multivariate analysis, male gender and IONB were independent predictors of better cognitive functioning, while long-term complications negatively affected emotional functioning. Conclusions: Obtained results suggest that an IONB can also be suitable for elderly patients compared with an IC with few and selected advantages in favour of the former UD. Preoperative patient’s selection, counselling, education and active participation in the decision-making process lead to a more suitable choice of treatment.

Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients

“…We found that choosing to perform a continent diversion was more frequent in younger patients, males, and those without comorbidities, treated in high-volume hospitals. This finding mirrors both the indication of a continent diversion together with a better quality of life achievable in this part of the population [15][16][17].…”

Assessment of health-related quality of life of male patients with ileal orthotopic neobladder compared to cutaneous ureterostomy

“…In addition, at a 3-year follow-up, the HR-QoL was even worse compared to 1-year follow-up, probably, because of the loss of hope for a successful recovery. Thus, ensuring more than 36 months of follow-up was found to be a critical factor in terms of postoperative changes in HR-QoL [ 24 ]. Follow-up duration of our study was consistent with the recommendations above.…”

Patient-reported outcomes and health-related quality of life after urinary diversions

“…Therefore, ONB is often performed on the younger and fitter patients, although Cerruto et al [9] observed in 2018 that ONB might be a good option in the elderly patient as well. Comparing ONB and ileal conduit after radical cystectomy in patients over 75 years of age, no significant difference was found regarding HRQOL.…”