(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL between April 28 and May 1st, 2023, was host to a podium session of invasive bladder cancer studies. Dr. Severin Rodler discussed the results of a study evaluating gender specific differences in health-related quality of life for bladder cancer patients after radical cystectomy using propensity score-matched analysis.
There is a well-established imbalance in the gender distribution of patients with newly diagnosed bladder cancer, with males over two-times more likely to be diagnosed with bladder cancer in their lifetime. Furthermore, women undergoing a radical cystectomy (RC) have disproportionately higher mortality rates compared to men.1 Patient-reported outcome measures (PROMs), including health-related quality of life (HRQoL), assessed via validated questionnaires, are a valuable tool to understand disease course post-RC. However, gender-specific differences in HRQoL following RC remain poorly defined. This is further complicated by the fact that there are gender imbalances in the validation cohorts of established HRQoL questionnaires used for bladder cancer patients:
- EORTC QLQ-C30: 76% men
- EORTC BLM30: 78% men
- FACT BI: 72% men
As such, the objective of this study was to identify gender-specific disparities in HRQoL following a RC.
This study included patients who underwent an RC between January 2006 and December 2020 at a single center. After applying the study eligibility criteria, 1,498 patients were identified (421 women, 1,077 men). Patients were subsequently propensity score-matched on age, BMI, pT stage, and choice of urinary diversion. The propensity score-matched cohort included 794 patients, with 397 each of women/men. PROMs were prospectively assessed at 3 months post-radical cystectomy and annually thereafter. The authors utilized the following questionnaires:
- EORTC QLQ-C30
- EORTC QLQ-BLM30
- FACT-BI
- ICIQ-SF
The authors performed separate modeling of longitudinal HRQoL for women and men. Spearman rank correlation at 12 months after RC was used to identify gender-specific factors associated with HRQoL.
Starting with the EORTC QLQ-C30 Global Health Status domain, the authors identified significantly worse outcomes in female patients from 48 to 96 months after RC as demonstrated below:
Next, the authors performed a subgroup analysis by type of diversion (orthotopic ileum neobladder versus ileal conduit). Female patients undergoing an orthotopic ileal neobladder had significantly worse PROMs compared to their male counterparts. However, no significant differences were observed between males and females receiving an ileal conduit.
Next, the authors evaluated the correlation between functional outcomes and EORTC QLQ-C30 Global Health Status. They noted the following:
- A negative correlation between improved general HRQoL and urinary continence
- No correlation between improved general HRQoL and sexual functioning
Further correlative analysis demonstrated:
- A positive correlation between improved general HRQoL and physical well-being
- A positive correlation between improved general HRQoL and social/family well-being for women, but not men
Dr. Rodler concluded his presentation as follows:
- This large and propensity-score matched cohort displays gender-specific differences in the natural course of HRQoL outcomes following RC
- Females reported significantly worse general HRQoL during long-term follow-up compared to males
- HRQoL correlates with physical functioning or urinary continence equally in females and males, with sexual functioning showing no correlation with general HRQoL for both genders
- A strong correlation between social/family well-being and improved general HRQoL was demonstrated for females only
Presented by: Severin Rodler, MD on behalf of Thilo Westhofen, MD, Urology Resident Physician, Universität München, Munich, Germany
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023
References: