Dr. Bochner on quality of life following radical cystectomy

In this video, Bernard H. Bochner, MD, FACS, discusses the background and notable findings from the European Urology study, “Health-related Quality of Life for Patients Undergoing Radical Cystectomy: Results of a Large Prospective Cohort,” for which he served as senior author. Bochner is the Sir Murray F. Brennan Chair in Surgery at Memorial Sloan Kettering Cancer Center in New York, New York.

Transcription:

Please describe the background for this study.

There's a perception among many people who manage patients with bladder cancer that following a radical cystectomy there is a significant change to patients' quality of life. The surgery itself affects several different organ systems, not just the urinary system. Sexual functioning can be altered, [and there can be] issues related to bowel function or the GI system. The surgery tends to be done in older patients; the average age of somebody undergoing a radical cystectomy is about 68 years old. Many patients have other comorbidities. [With a] large surgery being done in older folks, there's a concern that the long-term quality of life in patients may be significantly adversely affected. The goal of this study was to really evaluate the early- and intermediate-term quality of life in a large group of patients undergoing radical cystectomy and urinary reconstruction. This was done as a single-institution study at Memorial Sloan Kettering that included several hundred patients undergoing this procedure.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

The high-level findings of the study were focused on a variety of domains. This was a very dense study in that we used 14 standardized quality-of-life measures, and followed patients at different time points, both before and after their surgery. We got baseline readings on things about various body functions, overall functioning status, as well as a variety of psychological and social aspects of what they were facing. We then used the same measures along with some interview techniques, at 3 months, 6 months, a year, a year and a half, and 2 years following surgery. What we found was essentially what we've seen in the clinics now for several decades, which is that the majority of patients appear to get back to their baseline level of functioning. In our study, the reported outcomes basically clarified that. What it demonstrated was that overall quality of life, while decreased early on after surgery, meaning at the 3-month period, began to recover nicely by 6 months, and usually by a year, patients were reporting their baseline levels of overall quality of life. When we looked at all the various domains in these 14 different standardized measures—and again, these ranged from urinary function, bowel function, and sexual function—essentially, patients returned to baseline reported levels, usually, by about 1 year or so. There were 2 domains that demonstrated that they did not return to baseline levels. These were not particularly surprising. In the group of patients that underwent cystectomy and ileal conduit diversions, they did demonstrate a drop-off in their reported body image. This would make sense given the external appearance of the bag or the appliance that's needed. The other domain that did not return to baseline was sexual function. We saw this primarily in men, but we saw this in some women as well. Again, I think that this finding is not particularly surprising given that, related to cancer characteristics, we are really not doing a lot of nerve-sparing surgery on men. Again, it's related to the fact that with invasive bladder cancer, we're very focused on clearing all the tissues that surround the bladder and the base of the prostate, and that does require us to remove the nerve bundles. Many men also come into surgery with depressed overall erectile function. And even if we do attempt nerve preservation, we do see further drop-offs in their sexual functioning. So overall, I don't think that either one of these domains showing a drop-off was surprising. I think what surprised us was that the reported initial drop following surgery was much less significant than what I think the perception is for many people, and the rather rapid return to baseline in essentially all the other domains except for the 2 that I just mentioned was very gratifying to see.

This transcription was edited for clarity.