Gender Disparities in Health-related Quality of Life Outcomes Following Radical Cystectomy for Bladder Cancer

There is a gender imbalance regarding incidence and mortality in bladder cancer (BC), while gender-specific differences in health-related quality of life (HRQOL) following radical cystectomy (RC) remain unknown. We aimed to assess gender-specific differences in HRQOL after RC in a large prospective propensity score (PS)-matched cohort with follow-up of up to 10 yr.

A total of 1498 BC patients who underwent RC were included. PS matching of 794 patients (n = 397 female, n = 397 male) was conducted. HRQOL was assessed systematically by applying the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire QLQ)-C30, QLQ-BLM30, and Functional Assessment of Cancer Therapy-Bladder questionnaires. Separate modelling of longitudinal HRQOL for females versus males was performed. Generalised estimating equations (GEEs) were employed to account for repeated measures. Spearman's rank correlation was applied to identify gender-specific factors influencing HRQOL.

Baseline general HRQOL did not differ between female and male patients (p = 0.162). GEE modelling revealed females to report significantly worse global health status over time (β = 1.7, standard error [SE] = 0.4, p = 0.02). Among patients with disease recurrence, females reported worse general HRQOL than males in long-term follow-up (β = -3.8, SE = 1.7, p = 0.03). For patients without disease recurrence, we did not find a significant difference in general HRQOL between females and males (β = -0.83, SE = 1.2, p = 0.5). A significant correlation between general HRQOL, and urinary continence and physical-, functional-, or emotional well-being was observed for both genders (p range = 0.001-0.02). A strong correlation between social/family well-being and increased HRQOL was found for female (p = 0.001), but not for male (p = 0.1) patients.

Female patients report worse general HRQOL in long-term follow-up after RC, with different gender-specific factors influencing HRQOL.