Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial

Abstract

Purpose

Health related quality of life (HRQoL) is an important outcome in cancer care, although it is not well reported in surgical uro-oncology. Radical cystectomy (RC) with lymph-node dissection is the standard treatment of muscle-invasive bladder cancer and high-risk noninvasive bladder cancer. A wide range of impairments are reported postsurgery. The aims were to evaluate whether a standardized pre- and postoperative physical exercise program and enhanced mobilization can impact on HRQoL and inpatient satisfaction in RC, as defined by the European Organisation for Research and Treatment of Cancer (EORTC).

Materials and methods

Patients were randomized to fast-track RC and intervention (n_I=50) or fast-track standard treatment (n_S=57). HRQoL and inpatient satisfaction was measured using valid questionnaires: EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) combined with the disease-specific EORTC BLS24 (baseline), and EORTC BLM30 (follow-up), and IN-PATSAT32 inpatient-satisfaction survey at discharge. Efficacy was defined as the differences in HRQoL-scores between treatment groups at the 4-month follow-up.

Results

The intervention group significantly improved HRQoL scores in dyspnea (P≤0.05), constipation (P<0.02), and abdominal flatulence (P≤0.05) compared to the standard group. In contrast, the standard group reported significantly reduced symptoms in sleeping pattern (P≤0.04) and clinically relevant differences in role function, body function, and fatigue. The intervention did not compromise inpatient satisfaction.

Conclusion

We found no overall impact on global HRQoL due to a physical rehabilitation program. However, pre- and postoperative physical rehabilitation can significantly and positively impact on HRQoL aspects related to bowel management and respiratory function (dyspnea) without compromising inpatient satisfaction. These results highlight the role of multimodal rehabilitation, including physical exercises in fast-track RC.

Keywords:

• rehabilitation
• bladder cancer
• health-related quality of life
• physical exercise
• patient-reported outcome (PRO)

Acknowledgments

This study was carried out in a public health care system. The study was supported by Aarhus University Hospital (Denmark), the Dansac Foundation (Denmark), the Foundation of Inge Eriksen (Denmark), Nutricia (Denmark), the ML Joergensen Foundation (Denmark), Helse-Fonden (Denmark), the Novo-Nordic Nursing Research Foundation, and the Danish Cancer Research Foundation.

Disclosure

The authors report no conflicts of interest in this work.