Muscle-invasive bladder cancer: Quality of Care and Quality of Life in the Netherlands

The aim of this thesis was to get insight in the quality of care delivered to the Dutch patient with muscle-invasive bladder cancer. Furthermore, for the patients undergoing radical cystectomy, the gold standard therapy, the patient reported outcome quality of life was measured, before and after the operation. The results of the study show that the Dutch 10-year relative survival rate is 25%. This percentage has not changed during the last decade. In the process of deciding on the method of treatment, age plays a bigger part than comorbidity. For patients that had undergone a radical cystectomy, the 30 days postoperative mortality was significantly higher in low volume hospitals

Pre-diagnosis quality of life (QoL) in patients with hematuria: Comparison of bladder cancer with other causes

Purpose To examine quality of life (QoL), health status, sexual function, and anxiety in patients with primary hematuria who later appear to have bladder cancer (BC) and patients with other diagnoses. Methods From July 2007 to July 2010, 598 patients with primary hematuria were enrolled in this prospective, multicenter study. Questionnaires (WHOQOL-BREF, SF-12, IIEF, STAI-10-item Trait) were completed before cystoscopy. Diagnosis was subsequently derived from medical files. BC patients were compared with patients with other causes of hematuria. Results Cancer was diagnosed in 131 patients (21.9 %), including 102 patients (17.1 %) with BC. No differences were found in the WHOQOL-BREF versus SF-12 psychological or physical health domains. The erectile function was significantly worse in the BC group (9.3 vs. 14.6 for OC, p = 0.02). Patients with muscle-invasive BC (MIBC) had the lowest percentage anxious personalities of all BC patients (p = 0.04). Conclusions Cancer was found in 21.9 % of the patients with hematuria. Pre-diagnosis patients with BC have comparable QoL and HS to patients with OC. Erectile dysfunction was highest in patients with BC. MIBC patients had the lowest percentage anxious personalities of the patients with BC. Keywords: Quality of life, Health status, Hematuria, Bladder cancer, Erectile dysfunctio

Patient-reported outcomes for patients undergoing radical cystectomy: A prospective case-control study

Purpose The purpose of this study was to measure patient-reported outcomes (PROs) for patients with muscle-invasive bladder cancer (BC) before the diagnosis of BC was known, thus before cystectomy, and until 1 year postcystectomy. The differences in outcomes between a health status (HS) and quality of life (QoL) questionnaires were examined. Methods From July 2007 to July 2010, 598 patients with primary hematuria were enrolled in this prospective, multi-centre case–control (CC) study. Patients undergoing radical cystectomy (RC; N = 18) were compared with patients with other causes of hematuria (CC, N = 20). Measurement points were before diagnosis as well as 3, 6 and 12 months postcystectomy. Questionnaires used were the WHOQOL-BREF, SF-12, International Index of Erectile Function, and 10-item STAI-Trait scale. Results Prediagnosis patients who later appeared to have BC had the same QoL compared to CC patients. The prediagnosis physical component scale of HS and sexual function were significantly lower for RC vs. CC patients. RC patients had a better prediagnostic QoL and HS than postcystectomy at all time points. Conclusions This is the first case–control study with a baseline measurement of PROs before the diagnosis of BC was known. It shows lower physical health and sexual function for RC vs. CC before diagnosis is known. Until 1 year postcystectomy, QoL does not return to baseline level. Future studies including comorbidity and smoking history are needed to examine the generalizability of our results. Keywords: Muscle-invasive bladder cancer, WHOQOL-BREF, Quality of life, Cystectom

A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE VOLUME-OUTCOME RELATIONSHIP FOR THE RADICAL CYSTECTOMY: AN UPDATE FOR THE ONGOING DEBATE

Surgical oncolog

50 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE VOLUME-OUTCOME RELATIONSHIP FOR THE RADICAL CYSTECTOMY: AN UPDATE FOR THE ONGOING DEBATE

Surgical oncolog

Survival after treatment for carcinoma invading bladder muscle: a Dutch population-based study on the impact of hospital volume

Study Type - Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? The subject of mortality and survival rates after radical cystectomies in high-volume hospitals in comparison to low-volume hospitals has been extensively studied. Postoperative mortality is known to be significantly lower with high-volume providers, but for survival rates there was only a trend forwards this finding. For this reason, we performed this Dutch population-based study on survival rates, to see if we had enough power to support this trend with significant findings. To our knowledge, this is the first study of good quality showing a significant beneficial effect for survival in high-volume hospitals. OBJECTIVE: •  To examine the volume-outcome relationship for carcinoma invading bladder muscle (MIBC) with respect to differences in survival rates among all hospitals in the Netherlands as a guide for regionalization initiatives. MATERIALS AND METHODS: •  This population-based retrospective study included all patients (n= 13 033) newly diagnosed with MIBC during the period 1999-2008 in the Netherlands, selected from the Netherlands Cancer Registry. •  Data were collected on demographics, morphology, stage at diagnosis and after surgery, primary treatment, vital status and date of follow-up or death. •  The relative survival rate (RSR) per treatment was analysed for age, stage and hospital surgical volume. RESULTS: •  Overall 5 and 10-year RSR for all treatments of MIBC was 32% and 25%, respectively. •  Although 71.7% of the patients featured stages II and III, radical cystectomy was only performed in only 42% and 44% of these patients, respectively. •  Relative survival for MIBC remained unchanged in the two consecutive time periods (1999-2003 and 2004-2008). •  In all, 34% of patients diagnosed in low-volume hospitals (30 days after surgery) was significantly lower in patients after cystectomy for stage II/III in low-volume hospitals (hazard ratio [HR] 1.17, P= 0.036). A high lymph node count (>20) was associated with a lower risk of death (HR 0.52, P= 0.000). CONCLUSIONS: •  The 10-year RSR for patients with MIBC in the Netherlands was modest (25%) and has remained unchanged in the last decade. •  The chance of undergoing cystectomy is significantly higher in high-volume hospitals. Long-term survival after cystectomy is higher in high-volume hospitals. •  Regionalization of bladder cancer treatments could improve overall outcomes.Surgical oncolog

A Systematic Review and Meta-analysis of the Relationship Between Hospital/Surgeon Volume and Outcome for Radical Cystectomy: An Update for the Ongoing Debate

Surgical oncolog

Hospital-specific probability of cystectomy affects survival from muscle-invasive bladder cancer

Contains fulltext : 229162.pdf (Publisher’s version ) (Closed access)OBJECTIVES: Radical cystectomies (RCs) are increasingly centralized, but bladder cancer can be diagnosed in every hospital The aim of this study is to assess the variation between hospitals of diagnosis in a patient's chance to undergo a RC before and after the volume criteria for RCs, to identify factors associated with this variation and to assess its effect on survival. METHODS AND MATERIALS: Patients diagnosed with muscle-invasive bladder cancer (cT2-4a,N0/X,M0/X) without nodal or distant metastases between 2008 and 2016 were identified through the Netherlands Cancer Registry. Multilevel logistic regression analysis was used to investigate the hospital specific probability of undergoing a cystectomy. Cox proportional hazard regression analysis was used to assess the case-mix adjusted effect of hospital-specific probabilities on survival. RESULTS: Of the 9,215 included patients, 4,513 (49%) underwent a RC. The percentage of RCs varied between 7% and 83% by hospital of diagnosis before the introduction of the first volume criteria (i.e., 2008-2009; minimum of 10 RCs). This variation decreased slightly to 17%-77% after establishment of the second volume criteria (i.e., 2015-2016; minimum of 20 RCs). Age, cT-stage and comorbidity were inversely and socioeconomic status was positively associated with RC. Both being diagnosed in a community hospital and/or being diagnosed in a hospital fulfilling the RC volume criteria were associated with increased use of RC compared to academic hospitals and hospitals not fulfilling the volume criteria. For each 10% increase in the percentage of RC in the hospital of diagnosis, 2-year case-mix adjusted survival increased 4% (hazard ratio 0.96, 95% confidence interval 0.94-0.98). CONCLUSION: Probability of RC varied between hospitals of diagnosis and affected 2-year overall survival. Undergoing a RC was associated with age, cT-stage, socioeconomic status, type of hospital, and whether the hospital of diagnosis fulfilled the RC volume criteria. Future research is needed to identify patient, tumor, and hospital characteristics affecting utilization of curative treatment as this may benefit overall survival