HEALTH RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY IN ELDERLY PATIENTS WITH ILEAL ORTHOTOPIC NEOBLADDER OR ILEAL CONDUIT: RESULTS FROM A MULTICENTRE CROSS-SECTIONAL STUDY

INTRODUCTION AND AIM OF THE STUDY To evaluate health-related quality of life (HR-QoL) outcomes in elderly patients with two different types of urinary diversion (UD), ileal conduit (IC) and ileal orthotopic neobladder (IONB), after radical cystectomy (RC) for bladder cancer (BC), by using validated self- reported cancer-specific instruments. MATERIALS AND METHODS From January 2010 to December 2013 charts from 77 patients, aged 75 or older (median age 77 years), who received an IC (51) or an IONB (26) after RC at 5 urologic academic centres, were retrospectively reviewed. HR-QoL was evaluated, using a cross-sectional design, with Quality of Life Core Questionnaire and bladder module (BLM)-30 European Organisation for Research and Treatment of Cancer questionnaires, administered at last follow-up. RESULTS At univariate analysis, at a mean follow-up of 60.91 ± 5.63 months, IONB resulted favourable for the following HRQoL aspects: nausea and vomiting (p = 0.045), pain (p = 0.049), appetite loss (p = 0.03), constipation (p = 0.000), financial impact (p = 0.012), and cognitive functioning (p = 0.000). This last functional aspect was significantly worse in female patients (p = 0.029). Emotional functioning was significantly better in patients without long-term complications (p = 0.016). At multivariate analysis male gender and IONB was independent predictors of better cognitive functioning, while the presence of long-term complications negatively affected emotional functioning. INTERPRETATION OF RESULTS Quality of life represents one of themajor general factors able to affect the choice of urinary diversion after radical cystectomyfor bladder cancer. In elderly patients, IC is the most common UD performed because of its acceptable rate ofmajor complications and mortality in octogenarians, also preserving their quality of life. However, a statement by experts participating in the ICUDEAU international consultation on UDs for bladder cancer 2012 stated that they believe that HR-QoL of patients with wellfunctioning orthotopic bladder is significantly better than other forms of UDs (1). But not all patients withONB do equallywell and a few data in the literature address this topic in the elderly. Our results suggested that RC with IONB can be performed in elderly patients with few and selected advantages compared to IC,mainly in terms of cognitive functioning and bowel function. However, when there are not long-term complications with a well-functioning reservoir, both types of urinary diversion seem to be acceptable from the HR-QoL point of view with a satisfying global health status. Actually age, gender, follow-up length and long-term complications may represent important factors affecting the impact of the type of UD on patients’ HRQoL, when using generic disease-specific and urinary diversion specific questionnaires (2). Moreover gender represents an important factor affecting in-house complications and choice of UD as well as HR-QoL after RC. But it is not yet fully explored in the literature. Gacci, Saleh et al (3), in a series of only longterm disease-free female survivors after RC, did not find significant difference between IC and IONB subgroups; in contrast women with cutaneous ureterostomy endorsed a worse HR-QoL compared with those who underwent IC or IONB, mostly due to the worse physical and emotional perception of their body image. In our study, we found a significantworse HRQoL in female patients, regardless the type of UD, mainly in cognitive functioning. CONCLUSIONS The result of our cross- sectional study suggested that an IONB can be suitable also for elderly patients compared with an IC, few and selected advantages in favour of the former urinary diversion. However, both types of urinary diversion seem to be acceptable from the HR-QoL point of view. Preoperative patient's selection, counselling, education and active participation in the decision-making process allow a more suitable treatment in the elderlywithBCcandidate to a urinary diversion