Questionnaire assesses QoL in bladder cancer patients

Atlanta-Researchers from the University of Michigan have developed and validated a new questionnaire to assess health-related quality-of-life outcomes among patients treated for bladder cancer.

The instrument, known as the Bladder Cancer Index (BCI), covers all forms of urinary diversion and is valid for both sexes. It was introduced at the AUA annual meeting here.

"Although quality of life is an important endpoint for radical cystectomy, it is also of concern for endoscopic management, such as transurethral resection of the bladder, which is the treatment for the majority of bladder cancer cases," said lead author John T. Wei, MD, associate professor of urology at the University of Michigan, Ann Arbor. "Measuring quality of life requires thoughtful development with considerations of clinical relevance and psychometric properties."

The 316 patients in the study each completed the BCI and were stratified by treatment method: cystectomy/neobladder, cystectomy/ileal conduit, cystoscopy/intravesical therapy, and cystoscopy/no intravesical therapy. Median patient age was 69 years (range, 41 to 89 years), and median follow-up was 2.9 years (range, 0.2 to 9.8 years).

The investigators discovered differences among treatment groups for each of the BCI domains (p<.001). Interestingly, urinary domain scores were significantly lower (suggesting a lower health status) for the cystectomy/neobladder group (76.2) versus other groups (87.6 for ileal conduit, 89.7 for cystoscopy with intravesical treatment, and 90.7 for cystoscopy without intravesical therapy).

"Conventional wisdom is that orthotopic neobladders provide a more 'natural' bladder replacement because they preserve urethral voiding," Dr. Wei said. "Thus, patients and clinicians tend to associate them with a better quality of life."

However, Dr. Wei added, the neobladder is unlike a native bladder because it lacks coordinated neuromuscular voiding and continence mechanisms. In patients with an ileal conduit, on the other hand, continence is mainly dependent on proper placement of the stoma and conduit appliance, both of which have improved in recent years.

"Although we observed that the ileal conduit patients were more likely to report better disease-specific quality of life, we have to keep in mind that this was a cross-sectional survey study," Dr. Wei noted. "The selection biases that occur when patients and their physicians make decisions of which type of diversion to use may well have an effect."

Also of note was the fact that the cystoscopy/intravesical cohort posted a significantly higher bowel score when compared with both cystectomy groups (p<.005). The two cystoscopy groups fared better in sexual scores than did either cystectomy arm (p<.01).

Dr. Wei acknowledged that while a validated questionnaire is the best way to assess quality of life, clinicians may be challenged to find ways to efficiently incorporate them into their practice, given time constraints and the availability of resources.

Dr. Wei was assisted in the study by colleagues David Wood, MD, Scott Gilbert, MD, and Rod Dun, MS.