Einfluss der radikalen Zystektomie auf die Lebensqualität und Strategien für deren Erhalt

Zusammenfassung

Die radikale Zystektomie stellt einen wesentlichen Einschnitt in das Leben betroffener Patienten dar. Insbesondere ältere Patienten weisen nach radikaler Zystektomie oft eine begrenzte Lebenserwartung auf. Daher treten neben der reinen Tumortherapie insbesondere Aspekte der Lebensqualität in den Vordergrund.

In dieser narrativen Übersichtsarbeit wurden durch selektive Literaturrecherche Faktoren identifiziert, die einen Einfluss auf die Lebensqualität der betroffenen Patienten haben können. Dazu gehören neben Strategien zur Minimierung der perioperativen Morbidität eine optimale, individualisierte Therapieplanung. Diese sollte neben Faktoren wie Alter, Komorbiditäten, Wahl der Harnableitung auch altersspezifische, physiologische Gegebenheiten des Patienten wie die Gebrechlichkeit (Frailty) berücksichtigen. Patient-reported outcome measures (PROMs) sind essenzielle Instrumente, um die Lebensqualität standardisiert zu erfassen und sollten im klinischen Ablauf weiter etabliert werden.

Abstract

Radical cystectomy may have a major impact on the lives of affected patients. Older patients often have a reduced life expectancy after radical cystectomy. Therefore, aspects of health-related quality of life (HRQOL) have to be balanced against a solely tumour-directed therapy. In this narrative review, factors influencing the HRQOL of affected patients were identified and discussed by selective literature search.

Besides strategies to minimise perioperative morbidity, these include a patient-oriented and individualised treatment plan taking into account factors such as age, comorbidities, choice of urinary diversion and age-specific conditions, in particular frailty. Patient-reported outcome measures (PROMs) are crucial instruments to assess HRQOL outcomes and should be further implemented into routine clinical use.

Schlüsselwörter

Blasenkarzinom - Frailty - ERAS - Lebensqualität - HRQOL

Keywords

ERAS - HRQOL - bladder cancer - frailty

• Literatur

• 1 Ploussard G, Shariat SF, Dragomir A. et al. Conditional survival after radical cystectomy for bladder cancer: Evidence for a patient changing risk profile over time. Eur Urol 2014; 66
• 2 Stein JP, Lieskovsky G, Cote R. et al. Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1,054 patients. J Clin Oncol 2001; 19: 666-675
• 3 Mayr R, Gierth M, Zeman F. et al. Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer. J Cachexia Sarcopenia Muscle 2018;
• 4 Shalhoub PJ, Quek ML. Management of bladder cancer in the elderly: Clinical decision-making and guideline recommendations. Aging health 2010; 6: 607-610
• 5 Mânsson A, Mânsson W. When the bladder is gone: Quality of life following different types of urinary diversion. World J Urol 1999; 17: 211-218
• 6 Aziz A, May M, Burger M. et al. Prediction of 90-day Mortality After Radical Cystectomy for Bladder Cancer in a Prospective European Multicenter Cohort. Eur Urol 2014; 66: 156-163
• 7 Froehner M, Brausi MA, Herr HW. et al. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009; 56: 443-454
• 8 Rangarajan K, Somani BK. Trends in quality of life reporting for radical cystectomy and urinary diversion over the last four decades: A systematic review of the literature. Arab J Urol 2019; 17: 181-194
• 9 Luckett T, King MT, Butow PN. et al. Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: Issues, evidence and recommendations. Ann Oncol 2011; 22: 2179-2190
• 10 Danna BJ, Metcalfe MJ, Wood EL. et al. Assessing symptom burden in bladder cancer: An overview of bladder cancer specific health-related quality of life instruments. Bl Cancer 2016; 2: 329-340
• 11 Cookson MS, Dutta SC, Chang SS. et al. Health related quality of life in patients treated with radical cystectomy and urinary diversion for urothelial carcinoma of the bladder: Development and validation of a new disease specific questionnaire. J Urol 2003; 170: 1926-1930
• 12 Moncrief T, Balaji P, Lindgren B. et al. Comparative Evaluation of Bladder Specific Health Related Quality of Life (HRQOL) Instruments for Bladder Cancer. Urology 2017;
• 13 McIsaac DI, Bryson GL, Van Walraven C. Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: A population-based cohort study. JAMA Surg 2016; 151: 538-545
• 14 Nielsen ME, Shariat SF, Karakiewicz PI. et al. Advanced Age Is Associated with Poorer Bladder Cancer-Specific Survival in Patients Treated with Radical Cystectomy. Eur Urol 2007;
• 15 Hollenbeck BK, Miller DC, Taub D. et al. Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology 2004;
• 16 Bolenz C, Ho R, Nuss GR. et al. Management of elderly patients with urothelial carcinoma of the bladder: Guideline concordance and predictors of overall survival. BJU Int 2010; 106: 1324-1329
• 17 Goossens-Laan CA, Leliveld AM, Verhoeven RHA. et al. Effects of age and comorbidity on treatment and survival of patients with muscle-invasive bladder cancer. Int J Cancer 2014;
• 18 Fried LP, Tangen CM, Walston J. et al. Frailty in Older Adults: Evidence for a Phenotype. Journals Gerontol Ser A Biol Sci Med Sci 2001;
• 19 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. Journals Gerontol - Ser A Biol Sci Med Sci 2007;
• 20 Velanovich V, Antoine H, Swartz A. et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: Its application to a national database. J Surg Res 2013; 183: 104-110
• 21 Pearl JA, Patil D, Filson CP. et al. Patient Frailty and Discharge Disposition Following Radical Cystectomy. Clin Genitourin Cancer 2017; 15: e615-e621
• 22 Michel J, Goel AN, Golla V. et al. Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty. Urology 2019; 133: 25-33
• 23 Pazeto CL, Baccaglini W, Tourinho-Barbosa RR. et al. HRQOL related to urinary diversion in Radical Cystectomy: a systematic review of recent literature. Int Braz J Urol 2019; 45: 1094-1104
• 24 Yang LS, Shan BL, Shan LL. et al. A systematic review and meta-analysis of quality of life outcomes after radical cystectomy for bladder cancer. Surg Oncol 2016; 25: 281-297
• 25 Grimm T, Grimm J, Buchner A. et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol 2019; 37: 2385-2392
• 26 Zahran MH, Taha D-E, Harraz AM. et al. Health related quality of life after radical cystectomy in women: orthotopic neobladder versus ileal loop conduit and impact of incontinence. Minerva Urol Nefrol 2017; 69: 262-270
• 27 Zebic N, Weinknecht S, Kroepfl D. Radical cystectomy in patients aged ≥75 years: An updated review of patients treated with curative and palliative intent. BJU Int 2005; 95: 1211-1214
• 28 Cerantola Y, Valerio M, Persson B. et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced recovery after surgery (ERAS^®) society recommendations. Clin Nutr 2013;
• 29 Snowden CP, Prentis J, Jacques B. et al. Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people. Ann Surg 2013;
• 30 Gill TM, Baker DI, Gottschalk M. et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002; 347: 1068-1074
• 31 Jensen BT, Laustsen S, Jensen J. et al. Exercise-based prehabilitation is feasible and effective in radical cystectomy pathways-secondary results from a randomized controlled trial. Eur Urol Suppl 2016; 15: e332
• 32 Wuethrich PY, Studer UE, Thalmann GN. et al. Intraoperative continuous norepinephrine infusion combined with restrictive deferred hydration significantly reduces the need for blood transfusion in patients undergoing open radical cystectomy: Results of a prospective randomised trial. Eur Urol 2014; 66: 352-360
• 33 Pillai P, McEleavy I, Gaughan M. et al. A double-blind randomized controlled clinical trial to assess the effect of doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol 2011; 186: 2201-2206
• 34 Pang KH, Groves R, Venugopal S. et al. Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy. Eur Urol 2018;
• 35 Xiao J, Wang M, He W. et al. Does Postoperative Rehabilitation for Radical Cystectomy Call for Enhanced Recovery after Surgery? A Systematic Review and Meta-analysis. Curr Med Sci 2019; 39: 99-110
• 36 Giannarini G, Crestani A, Inferrera A. et al. Impact of enhanced recovery after surgery protocols versus standard of care on perioperative outcomes of radical cystectomy: a systematic review and meta-analysis of comparative studies. Minerva Urol Nefrol 2019; 71: 309-323
• 37 Ziegelmueller BK, Jokisch J-F, Buchner A. et al. Long-Term Follow-Up and Oncological Outcome of Patients Undergoing Radical Cystectomy for Bladder Cancer following an Enhanced Recovery after Surgery (ERAS) Protocol: Results of a Large Randomized, Prospective, Single-Center Study. Urol Int 2019;
• 38 Menon M, Hemal AK, Tewari A. et al. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 2003; 92: 232-236
• 39 Parekh DJ, Reis IM, Castle EP. et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 2018; 391: 2525-2536
• 40 Becerra MF, Venkatramani V, Reis IM. et al. Health-Related Quality of Life of Patients with Bladder Cancer in the RAZOR Trial - A Multi-Institutional Randomized Trial Comparing Robot versus Open Radical Cystectomy. J Urol 2020; 101097JU0000000000001029
• 41 Bochner BH, Dalbagni G, Sjoberg DD. et al. Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol 2015; 67: 1042-1050
• 42 Messer JCJC, Punnen S, Fitzgerald J. et al. Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int 2014; 114: 896-902
• 43 Kimura S, Iwata T, Foerster B. et al. Comparison of perioperative complications and health-related quality of life between robot-assisted and open radical cystectomy: A systematic review and meta-analysis. Int J Urol 2019; 26: 760-774
• 44 Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 2005;
• 45 Canter D, Viterbo R, Kutikov A. et al. Baseline renal function status limits patient eligibility to receive perioperative chemotherapy for invasive bladder cancer and is minimally affected by radical cystectomy. Urology 2011; 77: 160-165
• 46 Martini T, Gilfrich C, Mayr R. et al. The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians. Clin Genitourin Cancer 2016; 1-7
• 47 Feuerstein MA, Goldstein L, Reaves B. et al. Propensity-matched analysis of patient-reported outcomes for neoadjuvant chemotherapy prior to radical cystectomy. World J Urol 2019; 37: 2401-2407
• 48 Tang D, Leone A, Chipollini J. et al. Patient reported health and quality of life after neoadjuvant chemotherapy and cystectomy: Results from bladder cancer outcomes and impact study. J Urol 2017; 197: e931
• 49 McMullen CK, Kwan ML, Colwell JC. et al. Recovering from Cystectomy: Patient Perspectives. Bl Cancer 2019; 5: 51-61