Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial

Abstract

PurposeHealth related quality of life (HRQoL) is an important outcome in cancer care, although it is not well reported in surgical uro-oncology. Radical cystectomy (RC) with lymph-node dissection is the standard treatment of muscle-invasive bladder cancer and high-risk noninvasive bladder cancer. A wide range of impairments are reported postsurgery. The aims were to evaluate whether a standardized pre- and postoperative physical exercise program and enhanced mobilization can impact on HRQoL and inpatient satisfaction in RC, as defined by the European Organisation for Research and Treatment of Cancer (EORTC).Materials and methodsPatients were randomized to fast-track RC and intervention (nI=50) or fast-track standard treatment (nS=57). HRQoL and inpatient satisfaction was measured using valid questionnaires: EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) combined with the disease-specific EORTC BLS24 (baseline), and EORTC BLM30 (follow-up), and IN-PATSAT32 inpatient-satisfaction survey at discharge. Efficacy was defined as the differences in HRQoL-scores between treatment groups at the 4-month follow-up.ResultsThe intervention group significantly improved HRQoL scores in dyspnea (P≤0.05), constipation (P<0.02), and abdominal flatulence (P≤0.05) compared to the standard group. In contrast, the standard group reported significantly reduced symptoms in sleeping pattern (P≤0.04) and clinically relevant differences in role function, body function, and fatigue. The intervention did not compromise inpatient satisfaction.ConclusionWe found no overall impact on global HRQoL due to a physical rehabilitation program. However, pre- and postoperative physical rehabilitation can significantly and positively impact on HRQoL aspects related to bowel management and respiratory function (dyspnea) without compromising inpatient satisfaction. These results highlight the role of multimodal rehabilitation, including physical exercises in fast-track RC.

Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review

“…Porserud et al and Jensen et al both conducted RCTs comparing an exercise intervention group to a sedentary control group [10, 12]. There was a trend toward improvement in particular quality of life domains in the study by Porserud et al (Table 4).…”

“…Of these, two were cross-sectional surveys [9, 11] and two were randomized control trials [10, 12]. Both cross-sectional surveys used the Godin Leisure-Time Questionnaire to measure self-reported physical activity.…”

“…However, these differences were very small and only the improvement in the role physical domain reached statistical significance. Jensen et al described a medium-sized difference (10.5 points) in role function on the EORTC QLQ-C30 in the physical activity intervention group, but this failed to reach statistical significance [10, 12]. Neither study noted significant differences in global health scores.…”

Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial

“…The RC procedure is stated to be more complex, involving more organs, and therefore not directly comparable, and procedure-specific evidence is warranted on this subject [7,15]. So far, only one study has been evaluating the positive impact of both pre-and posthabilitation on health-related quality of life in a randomized design to RC patients [25]. In most domains important for the patient undergoing major surgery, health-related quality of life was significantly improved regarding respiratory function, mobilization, abdominal, and bowel aspects in the intervention group compared to standard.…”

The Efficacy of Early Mobilization after Urologic Radical Surgery

“…Ameliyat sonrası erken dönemde fiziksel aktivitenin sağlanması, ürolojik radikal cerrahi yapılan hastalar için sağlıkla ilgili yaşam kalitesi faktörlerinden birisidir. Radikal sistektomi yapılan 117 hastayı içeren randomize bir çalışmada multidisipliner fiziksel aktivite öncelikli 'fast track' cerrahi yaklaşımının özellikle barsak hareketleri ve solunum fonksiyonları ile ilişkili yaşam kalitesini arttırdığı belirtilmiştir (11). Dolayısıyla ürolojik cerrahiler sonrası da hastaların ameliyat sonrası durumu ve uygulanan cerrahinin tipi göz önünde bulundurularak, multidsipliner ekip yaklaşımla erken dönemde hastanın mobilizasyonu sağlanmalı ve sonrasında sık aralıklarla hastalar mobilize edilmelidir (9).…”