Differences in health-related quality of life between rural and urban bladder cancer patients following radical cystectomy.

Abstract

766 Background: Bladder cancer (BC) patients from rural areas (RA) may have more difficult access to health care with potentially detrimental impact on oncological outcome following radical cystectomy (RC). However, little is known on differences in health-related quality of life (HRQOL) between rural- and urban residents treated with RC for BC. We therefore aimed to assess these differences between rural and urban BC-patients by providing HRQOL data from a large prospective cohort of patients undergoing RC with a systematic follow-up of up to 10 yrs. Methods: n=1514 consecutive patients [n=576 from urban areas (UA), n=938 from rural areas (RA)] who underwent RC at a large tertiary care center were included. Exclusion criteria encompassed age <30 yr and RC due to benign diseases. HRQOL was assessed preoperatively, at 3 months, then annually until a maximum follow-up of 120 months, applying the validated EORTC QLQ-C30- as well as the bladder cancer-specific QLQ-BLM30- and FACT-BL-questionnaires. Separate modeling of longitudinal HRQOL for rural- and urban patients was performed. Spearman’s rank correlation was applied to identify residential-specific factors influencing HRQOL. Results: At baseline rural- and urban residents showed no significant difference in general HRQOL assessed by the global health status domain (GHS) (p=.983). In line no differences regarding symptom-related subscales were observed between both cohorts (p-range: .189 - .907). Postoperatively and in longitudinal analysis, rural residents reported significantly better general HRQOL up to 96 months after RC (p-range: .001 - .037). At 12 months, a significant correlation between physical-, emotional functioning or urinary continence and better general HRQOL was observed for both, rural- and urban residents (each p< .001). No significant correlation was found between sexual functioning and increased general HRQOL. While a significant correlation between Social/Family wellbeing and increased general HRQOL was found for rural residents (p=.042), no correlation was found for urban residents (p=.594). Conclusions: The current study provides prospective data from a contemporary cohort of BC-patients, which display residential-specific differences in the natural course of HRQOL following RC. Those results are important to guide individualized treatment decision-making for patients with BC.