Gender specific differences in health-related quality of life for patients with bladder cancer following radical cystectomy

Previous research has shown marked differences in diagnosis and oncological outcomes in male and female patients with bladder cancer. At ASCO GU 2023, Dr. Thilo Westhofen presented the results of a large-scale prospective study on gender-specific differences in the long-term quality of life of patients after radical cystectomy. Remarkably, women reported significantly worse general HRQoL in long-term follow-up compared to men.

Previously, an imbalance in gender-distribution of patients with newly diagnosed bladder cancer has been described. Women undergoing radical cystectomy (RC) for bladder cancer suffer from a disproportionately high mortality rate as compared to men. In addition, there is still much uncertainty about gender-specific differences in health-related quality of life (HRQoL) outcomes after RC. Dr. Westhofen aimed to assess those gender specific differences by providing HRQoL data from a large prospective propensity score-matched cohort of patients undergoing RC with a systematic follow-up of up to 10 years.

Study design

Patients were selected from a cohort of nearly 1,700 patients who underwent radical cystectomy between January 2006 and December 2020 at the Ludwig Maximilian University Hospital. Patients were excluded from the analysis if the cystectomy was performed as a salvage treatment for a benign condition or if their data was incomplete. A propensity-score matched analysis was performed with participants of each sex, matching patients 1:1. This analysis corrected for the confounders of age, BMI, cancer stage and type of urinary diversion. This resulted in a propensity-score matched cohort of 794 patients.

Patient reported outcome measures (PROMs) were measured prior to surgery, three months postoperatively, and then annually for up to 10 years. The questionnaires EORTC QLQ-C30 (physical, psychological and social functions), EORTC QLQ-BLM30 (targeting muscle-invasive bladder cancer), FACT-BI (physical, social, emotional and functional well-being of the patient with a subscale for bladder cancer) and ICIQ-SF (degree of urinary incontinence) were used to assess the patients’ HRQoL. Furthermore, longitudinal quality of life for men and women was assessed separately and a Spearman's rank correlation test was performed 12 months after cystectomy to identify gender-specific factors influencing HRQoL.

Results

A total of 421 female and 1,077 male patients were included in the unmatched cohort. After 1:1 matching, there were two balanced groups of 397 patients each. Longitudinal analysis of EORTC QLQ-C30 scores showed no difference between men and women before surgery and this remained the case until approximately 3 years after surgery. Thereafter, the EORTC QLQ-C30 score was higher in men than in women (p-values ​​between 0.002 and 0.045). A similar trend was seen in the subgroup of patients with an orthotopic ileum neobladder.

A negative correlation was found between improved general HRQoL and urinary continence in both men and women 12 months after surgery (both groups p< 0.05). In contrast, no correlation was found between sexual functioning and improved quality of life. However, a significant, positive correlation was shown between HRQoL and physical well-being. While in female patients a positive correlation was found between social and familial well-being and an increased HRQoL (p< 0.001), no correlation was found for men (p= 0.103).

Conclusion

This large and propensity-score matched cohort displays gender-specific differences in the natural course of HRQoL following radical cystectomy. Women reported significantly worse general HRQoL in long-term follow-up compared to men. HRQoL correlates with physical functioning or urinary continence equally in women and men, sexual functioning showed no correlation with general HRQoL for both genders. Finally, a strong correlation between social/family well-being and increased general HRQoL was found for women, not for men.

Reference

Westhofen T, et al. Gender specific differences in health-related quality of life for patients with bladder cancer following radical cystectomy. Presented at ASCO GU 2023; Abstract 437.