title: Quality of life in women undergoing urinary diversion for bladder cancer: results of a multicenter study among long-term disease-free survivors.
abstract: OBJECTIVE
  Women undergoing radical cystectomy (RC) and urinary diversion for bladder cancer experience substantial limitations in health-related quality of life (HRQOL). However, the level of discomfort caused by different urinary diversion has been never evaluated in long term survivors. The aim of this multicenter study is to evaluate differences in HRQOL among recurrence-free women undergoing cutaneous ureterostomy (CUS), Bricker's ileal conduit (BK-IC) and Orthotopic neobladder VIP (ONB-VIP) in disease-free females treated with radical cystectomy (RC), with long-term follow up (mean 60.1 months; range 36-122 months).
  
  
  METHODS
  All consecutively treated female patients from two urological institutions who underwent RC and urinary diversion from January 2000 to December 2008, with no evidence of tumor recurrence at a minimum follow up of 36 months, were included. Patients received the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL). Clinical data and questionnaire results were analyzed in order to evaluate the HRQOL differences among diversion groups.
  
  
  RESULTS
  We identified 37 females (median age: 68, range 45-82 years), including 12 status-post CUS, 16 who underwent BK-IC, and 9 who underwent ONB-VIP. Most were healthy (24/37 with no comorbidities, 4/37 Charlson 1-2, 9/37 Charlson 3 or greater - we didn't considered bladder cancer in Charlson evaluation because bladder cancer was the main inclusion criteria). Women undergoing CUS endorsed worse FACT-BL scores compared with BK-IC and ONB-VIP patients, worse HRQOL regarding physical and emotional well-being (p=0.008 and p=0.02, respectively), and a trend toward worse EORTC QLQ-C30 scores for appetite loss and fatigue (p=0.05 for both).
  
  
  CONCLUSIONS
  In our study long-term disease-free females treated with CUS endorsed worse HRQOL compared with women who underwent BK-IC or ONB-VIP, mostly due to worse physical and emotional perception of their body image.
authors.affiliation: Urologic Clinic I, University of Florence, AOU Careggi, Florence, Italy. maurogacci@yahoo.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Omar
authors.initials: O
authors.lastname: Saleh
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Masieri
authors.forename: Claudia
authors.initials: C
authors.lastname: Giannessi
authors.forename: Michele
authors.initials: M
authors.lastname: Lanciotti
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D014519:Ureterostomy / Q000523:psychology; D001749:Urinary Bladder Neoplasms / Q000523:psychology* / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods / Q000523:psychology*; D016476:Urinary Reservoirs, Continent