(UroToday.com) The 2023 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between February 16th and 18th was host to a session addressing challenges to ensure health equity in bladder cancer. Dr. Thilo Westhofen presented the results of his group’s study evaluating gender specific differences in health-related quality of life for bladder cancer patients following radical cystectomy.
Dr. Westhofen began his presentation by highlighting that there is a known imbalance in the gender distribution of patients with newly diagnosed bladder cancer. Females undergoing radical cystectomy for bladder cancer suffer disproportionately high mortality compared to males. Patient reported outcome measures (PROMs), including health-related quality of life (HRQoL) assessed by validated questionnaires, are a valuable tool to understand disease course following radical cystectomy. However, gender-specific differences in HRQoL following radical cystectomy remain unknown. There has been documented gender imbalances in the validation cohorts of established HRQoL questionnaires used for bladder cancer patients:
- EORTC QLQ C30: 76% male
- EORTC BLM30: 78% male
- FACT BI: 72% male
The objective of this study was to identify gender-specific disparities in HRQoL following radical cystectomy. In order to accomplish this, the authors identified all patients who underwent a radical cystectomy between January 2006 and December 2022 (n=1,688). They subsequently excluded patients who underwent a salvage radical cystectomy for benign disease (n=106) or had incomplete post-cystectomy data (n=84). This resulted in an ‘umatched’ cohort of 1,498 patients, of whom 421 (28.1%) were female. The investigators next performed a 1:1 propensity-score matching on the following variables: age, BMI, pT-stage, and choice of urinary diversion. This resulted in a propensity-score matched cohort of 794 patients (397 females and males, each). PROMs were prospectively assessed preoperatively, 3 months after radical cystectomy, and annually thereafter up to 10 years. Questionnaires used included:
- EORTC QLQ-C301
- EORTC QLQ-BLM30
- FACT-BI
- ICIQ-SF
Statistical analysis was conducted using:
- Separate modeling of longitudinal HRQoL for females and males
- Spearman rank correlation at 12 months after radical cystectomy to identify gender-specific factors influencing HRQoL
As demonstrated in the Table 1 below, the matched cohorts were well-balanced for the matching variables chosen. The median age was 70-71 years, 70% underwent an ileal conduit versus an orthotopic ileal neobladder in 28.2%, 22.8% had LN involvement, and positive margins were present in 13.6 – 16.6%.
With regards to the EORTC Quality of Life Questionnaire (QLQ)-C30 global health status domain, there were no significant differences between males and females for the first 36 months. Interestingly female patients had significantly worse EORTC QLQ-C30 global health status from 48 to 96 months post-radical cystectomy.
When analysis was restricted to patients undergoing an orthotopic ileal neobladder, a similar pattern was seen with disparate worsening of outcomes in females from 48 months onwards:
Conversely in patients undergoing an ileal conduit, no significant differences were seen at the different time points assessed:
Next, the authors assessed the correlations between functional outcomes and EORTC QLQ-C30 Global Health Status. There was a negative correlation between urinary continence and general HRQoL.
Conversely, there was no correlation between sexual functioning and general HRQoL measures.
Interesting results were observed when the correlation between social/family well-being and general HRQoL was stratified by sex:
- Females: Positive correlation between social/family well-being and general HRQoL
- Males: Absence of a correlation
There was a positive correlation between physical well-being and general HRQoL in the overall cohort.
Dr. Westhofen concluded his presentation as follows:
- This large and propensity-score matched cohort displays gender-specific differences in the natural course of HRQoL following radical cystectomy
- Females reported significantly worse general HRQoL in long-term follow-up compared to males
- HRQoL correlates with physical functioning and urinary continence equally in males and females; sexual functioning showed no correlation with general HRQoL for both genders
- A strong correlation between social/family well-being and improved general HRQoL was found for females, but not for males.
Presented by: Thilo Westhofen, MD, Urology Resident, Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.
References:
- Groenvold M, et al. Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 1997;50(4):441-50.