To compare health-related quality of life (HRQOL) using a broad range of validated measures in patients randomized to robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC).
We retrospectively analyzed patients that had enrolled in both an RCT comparing RARC vs ORC and a separate prospective study of HRQOL. The prospective HRQOL study collected 14 patient-reported outcomes measures preoperatively, and at 3-, 6-, 12-, 18-, and 24-months postoperatively. Linear mixed effects models with an interaction term (study arm×time) were used to test for differences in mean domain scores and differing effects of approach over time, adjusting for baseline scores.
A total of 72 patients were analyzed (n=32 RARC, n=40 ORC). From 3-24 months post-RC, no significant differences in mean scores were detected. Mean differences were small in the following EORTC QLQ-C30 domains: Global QOL (-1.1; 95% CI -8.4, 6.2), Physical Functioning (-0.4; 95% CI -5.8, 5.0), Role Functioning (0.7; 95% CI -8.6, 10.0). Mean differences were also small in bladder cancer-specific domains (EORTC QLQ-BLM30): Body Image (2.9; 95% CI -7.2, 13.1), Urinary Symptoms (8.0; 95% CI -3.0, 19.0). In Urostomy Symptoms, there was a significant interaction term (P <.001) due to lower ORC scores at 3- and 24-months. Other domains evaluating urinary, bowel, sexual, and psychosocial HRQOL were similar.
Over a broad range of HRQOL domains comparing RARC and ORC, there are unlikely to be clinically relevant differences in the medium to long-term and therefore HRQOL over this time period should not be a consideration in choosing between approaches.
The Journal of urology. 2023 Feb 01 [Epub ahead of print]
Matthew B Clements, Benjamin B Beech, Thomas M Atkinson, Guido M Dalbagni, Yuelin Li, Andrew J Vickers, Harry W Herr, S Machele Donat, Daniel D Sjoberg, Amy L Tin, Jonathan A Coleman, Bruce D Rapkin, Vincent P Laudone, Bernard H Bochner
Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York.