Prospective health-related quality of life in women undergoing radical cystectomy and urinary diversion.

Abstract

To assess health-related quality of life (HRQoL) in women undergoing radical cystectomy (RC) for bladder cancer, focusing on identifying the pattern of recovery among women and any gender-specific differences. We analysed a prospective study of HRQoL in 411 participants undergoing RC (88 females), including 14 patient-reported outcome measures over 2 years of follow-up. Generalised estimating equation models were used to estimate recovery in domain scores among women and analyse baseline HRQoL (among women based on diversion type and then comparing outcomes to males). Women who received a continent diversion (vs ileal conduit) had lower baseline Body Image (P = 0.037) and Social Functioning scores (P = 0.046). In comparison to men, women had lower baseline Social Functioning (P = 0.033), Body Image (P = 0.011), Sexual Functioning (P < 0.001), Emotional Functioning (P < 0.001), and Mental Health (P < 0.001). Postoperatively, considerable improvements were seen in women for psychosocial health domains, but Emotional Functioning (P < 0.001) and Mental Health (P = 0.024), for instance, remained meaningfully lower among women despite the improvements. Domains such as Physical Functioning (P = 0.2) and Global QoL (P = 0.12) were similar, although Pain (P = 0.026) and Fatigue (P = 0.031) were worse in women postoperatively. Women exhibit a similar, positive recovery trajectory in HRQoL after RC. However, both pre- and postoperatively, there are meaningfully lower psychosocial domain scores. Lower baseline Sexual Functioning scores and the differences observed in continent and ileal conduit diversion suggests tailored attention to this area in women. These findings have clinical implications for additional attention to psychosocial and emotional health during recovery after RC.