膀胱癌有無膀胱根除手術後生活品質的動態變化
蔡育賢1、吳姿誼2、歐妃雅1、歐建慧1、鄭鴻琳1、蔡宗欣3、楊文宏1、王榮德4
國立成功大學醫學院附設醫院 泌尿部1；職業暨環境衛生部公衛所4；中研院經濟所2；台南市立安南醫院3
Dynamic changes of quality of life in bladder cancer survivors with and without radical cystectomy
Yuh-Shyan Tsai1, Tzu-Yi Wu2, Fat-Ya Ou1, Chien-Hui Ou1, Hong-Lin Chen1, Tzong-Shin Tzai3,4, Wen-Horng Yang1, Jung-Der Wang5
1Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2 Institute of Economics, Academia Sinica, Taipei, Taiwan. 3,4Tainan An-Nan Hospital and China Medical University 5Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Purpose: Bladder cancer is the ninth most frequently-diagnosed cancer worldwide. Quality of life is a major concern of patients receiving radical cystectomy and deserved attention. We aimed to explore the dynamic changes and possible effects of radical cystectomy on health-related quality of life in bladder cancer survivors.
Materials and methods: Patients with bladder cancer were recruited in this study. We used the World Health Organization Quality of Life –Brief (WHOQOL-Bref) version to assess the patients’ quality of life. Kernel smoothing method was used to illustrate the dynamic changes of the domain and item scores after treatment. Mixed effects models were applied to determine the effects of radical cystectomy on scores of each item and domain of WHOQOL after controlling demographic and clinical factors.
Results: We collected 878 repeated measurements from 344 bladder cancer patients. 52 of them received radical cystectomy. Patients with radical cystectomy showed slightly lower scores in 4 domains. Construction of mixed effects model showed significant lower scores on items of sexual activity among survivors with cystectomy after control of confounding by marital status, monthly family income and comorbidities. Such an effect, however, seemed to decrease after age 60 or older.
Conclusion: Radical cystectomy may have a long-term effect on patients’ health related quality of life, especially on sexual life. But its impact appeared ameliorated after age 60, especially on those above 70.