Improving Patient-Centered Care After Urinary Diversion

Patients with bladder cancer who undergo cystectomy and urinary diversion face numerous challenges with significant implications for their quality of life (QOL). In recent years, there has been a growing interest in elucidating and addressing issues affecting postsurgical QOL in these patients.

“Like all major surgeries, radical cystectomy and urinary diversion will come with a recovery period in which energy levels and physical functioning can change,” Bernard H. Bochner, MD, the Sir Murray F. Brennan Chair in Surgery at Memorial Sloan Kettering Cancer Center in New York, explained in an interview [personal communication; February 2023]. “In patients undergoing these procedures, issues associated with body function — urinary, bowel, and sexual function — as well as overall activity and emotional well-being can be affected by surgery, and these changes have the potential to adversely affect a patient’s QOL.”

QOL After Urinary Diversion

In a single-center retrospective study, Dr Bochner and colleagues examined patient-reported outcome measures to assess health-related QOL (HRQOL) following radical cystectomy in a cohort of 411 patients. The results showed that most areas of functioning, including physical and social, and most psychosocial domains, eventually returned to or exceeded baseline values, and global QOL scores surpassed baseline scores.¹

Overall, the findings indicate that “by 6 months to 1 year after surgery, most people report QOL outcomes similar to what they experienced prior to surgery,” Dr Bochner said. “Issues that remained negatively affected and did not return to baseline were related to sexual function and, in patients who received an ileal conduit urinary diversion, body image.”

These results align with those reported in previous studies conducted in this patient population. “To date, most of the research examining how urinary diversion impacts patient-reported QOL has demonstrated that patients generally adapt well after surgery and have QOL scores that return to near-normal levels within 6 months after surgery,” according to Scott M. Gilbert, MD, senior member in the department of genitourinary oncology at Moffitt Cancer Center in Tampa, Florida [personal communication; February 2023].

In addition to the study by Bochner et al, for example, a 2021 observational study assessed QOL in 382 patients who underwent radical cystectomy with urinary diversion, based on scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORT QLQ-C30). All participants reported general improvements in QOL, HRQOL, and global health status from 1 month before surgery to the 6-month follow-up after surgery (P <.001), and no significant differences in QOL were found between patients receiving a neobladder or urostomy.²

“Every type of urinary diversion comes with some type of change, from a stoma and urinary appliance that is part of an ileal conduit, to routine maintenance care, self-catheterizations, and retraining with a neobladder,” explained Dr Gilbert. While QOL scores do tend to normalize after surgery in most cases, patients who “struggle to care for their diversions or experience complications related to them tend to report lower than average QOL scores.”