Bladder cancer: QoL scores similar whether patients have robotic or open cystectomy

Bladder cancer patients’ reported health quality of life in the months following radical cystectomy is similar whether they have had an open or robotic approach, according to a new study published in the Journal of Urology.¹

“Preoperative patient counseling in this regard is important,” said study author Vivek Venkatramani, MD, a urologic oncology fellow at the University of Miami Miller School of Medicine in Florida at the time the research was undertaken. Quality of life is an often-neglected indicator after major surgery, according to Venkatramani, who now practices as a uro-oncologist and robotic surgeon at the Nanavati Super Speciality Hospital in Mumbai, India.

The investigators analyzed data from the RAZOR trial (NCT01157676), which included assessments of health-related quality of life using the Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index (FACT-VCI) and the Short Form-8 (SF-8) health survey at baseline and 3 and 6 months after surgery. The FACT-VCI measures bladder cancer–specific health quality of life, assessing physical, social, emotional, and functional well-being. The SF-8 measures physical and mental components of patients’ health.

Venkatramani and colleagues found no statistically significant differences between mean FACT-VCI composite or subscale scores. The emotional well-being of patients who had radical cystectomy improved over time in both arms.

There was 1 significant difference in the findings: Patients who had open radical cystectomy were more likely than patients who had robotic cystectomy to report better SF-8 scores in physical and mental health at 6 months compared to baseline, according to the study.

“A diagnosis of cancer has a significant impact on a patient’s emotional and mental well-being. The improvement in emotional well-being score postoperatively can perhaps be attributed to the fact that patients believed that the cancer had been tackled and they were now free of disease,” Venkatramani said. “Patients undergoing open radical cystectomy also showed better physical and mental Short Form- 8 scores at 6 months compared to preoperatively, suggesting that mental health is probably significantly affected with a cancer diagnosis and undergoing successful surgery helps to improve this. The exact significance of improvement in physical scores is unclear and could be related to symptomatic relief from pain and hematuria following surgery.”

The investigators also found that continent diversion was associated with worse FACT-VCI scores at 3 months but not at 6 months compared to noncontinent diversion. Patients with continent diversion reported better scores at 6 months according to the SF-8 physical component than patients with noncontinent diversion.

“The worsening of Functional Assessment of Cancer Therapy cystectomy score at 3 months in continent diversions could be related to the initial training and adjustment period a patient needs to get comfortable with their continent diversion and potentially to their higher expectations going into the procedure,” Venkatramani said. “The better physical component of Short Form 8 in continent versus incontinent diversions at 6 months is difficult to explain and the clinical significance is unclear. Our study was not powered to detect significant differences between diversion types. These findings may be purely statistical in nature and need confirmation with well-powered prospective studies to determine their clinical significance.”

It is important for urologists transitioning from one surgical approach to another to determine whether there is a true benefit justifying the change. This study shows no difference in the quality of life between patients undergoing open or robotic surgery. Rather, differences following surgery were related to the control of cancer and adjustments with urinary diversion.

Venkatramani said he explains to patients that mental and emotional well-being is likely to improve following surgery with the understanding that the major step in treatment has been completed. This is regardless of the surgical approach used.

“Physical quality of life is likely to be significantly impacted immediately following surgery. Once the patient has recovered from the immediate effects of surgery and begins to adjust and settle with the urinary diversion selected, physical quality of life will improve and return to baseline by about 6 months and may further improve with time,” he said.

Reference

1. Becerra MF, Venkatramani V, Reis IM, et al. Health related quality of life of patients with bladder cancer in the RAZOR trial: a multi-institutional randomized trial comparing robot versus open radical cystectomy. J Urol. 2020;204(3):450-459. doi:10.1097/JU.0000000000001029