Quality-of-life assessment in patients with bladder cancer

Health-related quality of life (HRQOL) in patients with bladder cancer is important, because radical cystectomy and urinary diversion significantly affect urinary and sexual function, and lead to associated sex-specific morbidity. This article reviews the current methods for defining HRQOL, describes the specific challenges in measuring HRQOL in patients with bladder cancer, and critically analyzes the existing literature on bladder cancer HRQOL. Previous studies have been limited by study design, generalizability, and by the different instruments used, namely nonvalidated questionnaires that are not specific for bladder cancer. To date, only two prospective studies with baseline HRQOL data have been published and few conclusions can be drawn from these cross-sectional, retrospective studies. On the basis of the published literature, there is no convincing evidence that superior HRQOL is achieved with a particular type of urinary diversion after cystectomy for bladder cancer. Patients should be counseled on all reconstructive alternatives and a diversion chosen on the basis of patient preference, patient anatomy and tumor status, rather than on a potential difference in HRQOL. Prospective studies with appropriate adjustment for confounding factors, which use validated and disease-specific questionnaires, are needed for HRQOL research on bladder cancer.