Quality of life in patients with non-muscle-invasive bladder cancer: one-year results of a multicentre prospective cohort study.

OBJECTIVE: Few studies describe the effect of non-muscle-invasive bladder cancer (NMIBC) on health-related quality of life (HRQL), although patients are mostly diagnosed at this stage of the disease. Taking into account this current evidence gap and the high incidence rates in Spain, we aimed to describe the evolution over time of HRQL in Spanish patients with NMIBC and to examine the clinical and treatment-related factors associated with HRQL change during the first year of management. METHODS AND MATERIALS: Observational multicenter prospective inception cohort study conducted in urology departments of 7 Spanish hospitals. A consecutive sample of 244 patients with anatomopathologically confirmed NMIBC, recruited from October 2010 to September 2011, was followed during the diagnostic process, and 6 and 12 months later. HRQL was assessed by generic and disease-specific instruments: the Short Form-36 (covering physical and mental health) and the Bladder Cancer Index, measuring urinary, bowel, and sexual domains (summary scores: 0-100). Bivariate analysis was performed and generalized estimating equation models were constructed to assess HRQL score change. RESULTS: Almost 52% of the patients were diagnosed at stage I, and 84% were men. The number of patients treated only with transurethral resection (TUR) was 144, and 82 also received intravesical therapy with bacillus Calmette-Guérin (BCG) or mitomycin C. Mental health was significantly worse than Short Form-36 reference norms at diagnosis (mean of 49.7 vs. 53.3, 95% CI: 52.5-54.2). Urinary domain improved significantly from diagnosis (85.2, 95% CI: 82.9-87.4) to 12-month evaluation (90.2, 95% CI: 87.7-92.8), whereas sexual domain showed deterioration from 56.4 (95% CI: 52.8-59.9) to 53.7 (95% CI: 50.0-57.4). Adjusted HRQL score changes from baseline to 12-month follow-up estimated with generalized estimating equation models showed improvement on the following parameters: urinary domain after TUR with or without intravesical therapy (+3.9, 95% CI: 0.1-7.7), bowel domain among patients treated with TUR and BCG (+7.0, 95% CI: 2.4-11.5), and sexual domain among those treated with TUR and mitomycin C (+13.1, 95% CI: 5.9-20.2). CONCLUSIONS: For the first time, a distinctive HRQL pattern of bladder cancer treatment benefits emerges for TUR alone, and in combination with BCG or mitomycin C, which deserves further research. Treatment differences cannot be interpreted in terms of efficacy but can be useful to generate hypotheses to test in future studies.

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation.

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.

[Perioperative morbidity of radical prostatectomy in patients over 70 years of age]. / Morbilidad perioperatoria de la prostatectomía radical en pacientes mayores de 70 años.

INTRODUCTION: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. OBJECTIVES: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy in patients older than 70 years. MATERIAL AND METHODS: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. RESULTS: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinaryi fistula (15%) respectively. CONCLUSIONS: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice.