Quality of Life in Long-term Survivors of Muscle-Invasive Bladder Cancer

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• 作者：Kimberley S. Mak ; MD ; MPH^&lowast ; ; ^&dagger ; ; Angela B. Smith ; MD ; MS^&Dagger ; ; Alec Eidelman ; BS^&sect ; ; Rebecca Clayman ; BS^&sect ; ; Andrzej Niemierko ; PhD^&sect ; ; Jed-Sian Cheng ; MD^&sect ; ; Jonathan Matthews ; MPH^&Dagger ; ; Michael R. Drumm ; AB^&sect ; ; Matthew E. Nielsen ; MD ; MS^&Dagger ; ; Adam S. Feldman ; MD ; MPH^&sect ; ; Richard J. Lee ; MD ; PhD^&sect ; ; Anthony L. Zietman ; MD^&sect ; ; Ronald C. Chen ; MD ; MPH^&Dagger ; ; William U. Shipley ; MD ; FACR ; FASTRO^&sect ; ; Matthew I. Milowsky ; MD^&Dagger ; ; Jason A. Efstathiou ; MD ; DPhil^&sect ; ; ^{jefstathiou@partners.org}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 December 2016
• 年：2016
• 卷：96
• 期：5
• 页码：1028-1036
• 全文大小：251 K
• 卷排序：96

文摘

Health-related quality of life (QOL) has not been well-studied in survivors of muscle-invasive bladder cancer (MIBC). The present study compared long-term QOL in MIBC patients treated with radical cystectomy (RC) versus bladder-sparing trimodality therapy (TMT).Methods and MaterialsThis cross-sectional bi-institutional study identified 226 patients with nonmetastatic cT2-cT4 MIBC, diagnosed in 1990 to 2011, who were eligible for RC and were disease free for ≥2 years. Six validated QOL instruments were administered: EuroQOL EQ-5D, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire and EORTC MIBC module, Expanded Prostate Cancer Index Composite bowel scale, Cancer Treatment and Perception Scale, and Impact of Cancer, version 2. Multivariable analyses of the mean QOL scores were conducted using propensity score matching.ResultsThe response rate was 77% (n=173). The median follow-up period was 5.6 years. Of the 173 patients, 64 received TMT and 109, RC. The median interval from diagnosis to questionnaire completion was 9 years after TMT and 7 years after RC (P=.009). No significant differences were found in age, gender, comorbidities, tobacco history, performance status, or tumor stage. On multivariable analysis, patients who received TMT had better general QOL by 9.7 points of 100 compared with those who had received RC (P=.001) and higher physical, role, social, emotional, and cognitive functioning by 6.6 to 9.9 points (P≤.04). TMT was associated with better bowel function by 4.5 points (P=.02) and fewer bowel symptoms by 2.7 to 7.1 points (P≤.05). The urinary symptom scores were similar. TMT was associated with better sexual function by 8.7 to 32.1 points (P≤.02) and body image by 14.8 points (P<.001). The patients who underwent TMT reported greater informed decision-making scores by 13.6 points (P=.01) and less concern about the negative effect of cancer by 6.8 points (P=.006). The study limitations included missing baseline QOL data and different follow-up times.ConclusionsBoth TMT and RC result in good long-term QOL outcomes in MIBC survivors, supporting TMT as a good alternative to RC for selected patients. Whether TMT leads to superior QOL requires prospective validation.