Society of Urologic Oncology (SUO) 21st Annual Meeting

SUO 2020: Factors Associated with Decision Regret in Patients Undergoing Radical Cystectomy and Urinary Diversion

( Dr. Elizabeth Green was invited to speak during the last bladder cancer session of the 2020 Society of Urologic Oncology (SUO) annual meeting. Her group has investigated factors associated with decisional regret in patients undergoing radical cystectomy and urinary diversion.

While radical cystectomy is the standard of care for muscle-invasive bladder cancer, the surgery and associated urinary diversions are known to have significant effects on subsequent quality of life. As with other major surgeries, this may lead to patients regretting their decision to pursue expiritive therapy. Despite this little research has been devoted to characterizing the factors associated with decision regret in this patient population.

To that end, Dr. Green and her colleges prospectively collected quality of life information from 132 cystectomy patients. The participants underwent surgery between 2014 and 2016 and were followed for one year. During that time, they completed a series of questionnaires including the Bladder Cancer Index (BCI), Body Image Scale (BIS), Patient Health Questionnaire-8 (PHQ-8), Medical Outcomes Study Sleep Scale (MOS-Sleep), and Medical Outcomes Study Short Form (SF-36). Answers to these surveys were collected prior to cystectomy and at 3, 6, and 12 months after surgery. The Coping Strategy Indicator (CSI) was collected at baseline and the Decision Regret Scale (DRS) was collected at 3, 6, and 12 months after surgery.

At baseline, the majority of assays were equivalent in all patients, the exception being, sexual function, and depressive symptoms. Sexual function was worse in patients with an ileal conduit (IC) than those with a neobladder (NB) or catheterizable pouch (p=0.009, Table 1). Pouch patients had more depressive symptoms than IC or NB patients (P=0.042).


Following surgery, the authors showed that the degree of decision regret varied across diversion type. Pouch patients endorsed the most regret followed by NB and IC patients (P=0.048). Furthermore, pouch patients had lower urinary BCI (P<0.001), body image (P=0.002), SF-36 physical scores (P=0.002), and more sleep problems (P=0.018) than those with NB or IC.

To evaluate the factors associated with regret, the authors looked at several demographic and pathologic patient characteristics, in addition to the collected quality of life date. Dr. Green explained that only diversion type and quality of life were associated with decision regret on univariate analysis and on multivariable analysis, the body image scale was found to be the only independent predictor. There was no association between decision regret and demographics, pathology, and baseline quality of life measures.

Traditional counseling for a radical cystectomy and urinary diversion does not often include a large discussion regarding body image. This study, however, revealed the importance of this for patients, highlighting a potential area for improved communication in order to reduce regret and distress following surgery.

Presented by: Elizabeth A. Green, MD, Chief Resident, Vanderbilt University Medical Schol, Nashville, Tennessee

Written by: Adrien Bernstein, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Fox Chase Cancer Center, Philadelphia, PA, at the 21st Annual Meeting of the Society of Urologic Oncology (SUO), December 3-5, Virtual Conference 


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