Introduction:

With multiple options for urinary diversion following radical cystectomy, health related quality of life (HRQOL) is an important consideration during the shared decision-making process with patients being treated for bladder cancer.  We aimed to characterize the HRQOL reported by patients who underwent a radical cystectomy for bladder cancer with respect to ileal conduit, Indiana pouch, or neobladder urinary diversion utilizing the Functional Assessment of Cancer Therapy-Bladder Cystectomy (FACT-Bl-Cys) validated patient health survey at various time points postoperatively.

Methods:

The FACT-Bl-Cys survey was administered to 146 patients with bladder cancer undergoing radical cystectomy and urinary diversion at Indiana University from 2015-2018.  Surveys were then completed prior to radical cystectomy and longitudinally throughout the post-operative course and retrospectively reviewed. 

Results:

Of the 146 patients completing questionnaires with a mean of over 12 months, 84 (57.6%) received an ileal conduit, 31 (21.2%) an Indiana pouch, and 31 (21.2%) an orthotopic neobladder.  76.7% of the patients were male.  The mean (SD) FACT-Bl-Cys (0-168) pre- and post-operative scores amongst all diversion types were 120.15 (23.82) and 123.75 (22.88), possibly indicating perceived improvement in quality of life after treatment for bladder cancer with cystectomy.  Patients who received an ileal conduit had the largest percent increase in HRQOL scores (5.96%), followed by Indiana Pouch (1.1%). Neobladder patients had an average decrease in HRQOL scores by (3.2%).  There was no significant difference in Physical Well-Being subscores or the Social/Family Well-Being subscores between diversion types.  The highest Functional Well-Being subscores were seen in the ileal conduit group, there was no change seen in the Indiana pouch group.  In evaluating the treatment-specific cystectomy instrument results, the highest subscore increase was seen in the ileal conduit group and there was a decrease in subscores seen in the neobladder group.  Emotional Well-Being scores increased amongst all diversion groups.

Conclusion:

To our knowledge this is the first longitudinal analysis comparing quality of life in patients after receiving an ileal conduit, Indiana pouch, or neobladder urinary diversion utilizing a standardized, validated, treatment-specific patient health survey.  Proper preoperative counseling is critical to ensure understanding about the benefits of continence vs noncontinent diversion types within the first year postoperatively.

Funding: N/A