Utility of Patient-Reported Symptom and Functional Outcomes to Indicate Recovery after First 90 Days of Radical Cystectomy: A Longitudinal Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Data Collection and PRO Measurement
2.3. Objective Physical Functioning Measure
2.4. Statistical Analysis
3. Results
3.1. Participants
3.2. Application of MDASI-PeriOp-BLC
Patient Compliance
3.3. Trajectory Membership of Postoperative Symptom Functioning Recovery
3.4. Impact of Symptom Severity on Postoperative Function Recovery
3.5. Compliance with Objective and Subjective Measures of Physical Functioning
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient Characteristics | Mean (SD) | Median (Range) |
---|---|---|
Age, years | 66.52 (9.3) | 66.62 (39.71–86.39) |
Frequency | Percent | |
Age Group | ||
<65 | 22 | 42.31 |
≥65 | 30 | 57.69 |
Sex | ||
Men | 45 | 86.54 |
Women | 7 | 13.46 |
Race | ||
White | 49 | 94.23 |
Others | 3 | 5.77 |
Ethnicity | ||
Hispanic or Latino | 2 | 3.85 |
Not Hispanic | 50 | 96.15 |
Marital Status | ||
Married/Partnered | 41 | 78.85 |
Single/Others | 11 | 21.15 |
Education | ||
High School | 11 | 21.15 |
College | 34 | 65.38 |
Graduate/Professional training | 7 | 13.46 |
Job status | ||
Employed outside the home | 21 | 40.38 |
Homemaker/Retired | 26 | 50 |
Medical leave/disable due to illness | 5 | 9.62 |
ECOG | ||
Missing | 2 | 3.85 |
Good (0–1) | 47 | 90.38 |
Poor (2–3) | 3 | 5.77 |
Charlson Comorbidity Index | ||
0 | 2 | 3.85 |
1–2 | 25 | 48.08 |
3–4 | 18 | 34.62 |
5–7 | 7 | 13.46 |
Bladder Cancer Stage (Tumor) | ||
Ta | 2 | 3.85 |
Tis | 5 | 9.62 |
T1 | 20 | 38.46 |
T2 | 21 | 40.38 |
T3 | 4 | 7.69 |
Bladder Cancer Stage (Node) | ||
N0 | 49 | 94.23 |
N1 | 3 | 5.77 |
Bladder Cancer Stage (Metastasis) | ||
M0 | 51 | 98.08 |
M1 | 1 | 1.92 |
Under ERAS Pathway | ||
No | 1 | 1.92 |
Yes | 51 | 98.08 |
Intraoperative Complications | ||
No | 52 | 100 |
Yes | 0 | 0 |
Postoperative Complications | ||
No | 26 | 50 |
Yes | 26 | 50 |
Recurrent disease | ||
No | 42 | 80.77 |
Yes | 10 | 19.23 |
Neoadjuvant chemotherapy | ||
No | 17 | 32.69 |
Yes | 35 | 67.31 |
Baseline | Discharge (6 Days Post-Surgery ± 2 Days) | End of Study (89 Days Post-Surgery ± 2.5 Days) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean (SD) | % ≥5 | % ≥7 | n | Mean (SD) | % ≥5 | % ≥7 | n | Mean (SD) | % ≥5 | % ≥7 | |
Single Item Quality of Life | 52 | 7.04 (2.82) | 86.54 | 67.31 | 43 | 6.19 (2.39) | 81.40 | 46.51 | 39 | 5.82 (3.01) | 69.23 | 53.85 |
EQ-5D VAS Score *,† | 52 | 74.33 (22.55) | - | - | 43 | 65.40 (16.19) | - | - | 39 | 78.08 (18.15) | - | - |
MDASI-Core Symptom Items | ||||||||||||
Pain * | 52 | 0.83 (1.45) | 3.85 | 0 | 41 | 3.51 (2.49) | 29.27 | 17.07 | 40 | 1.45 (2.02) | 10 | 5 |
Fatigue * | 52 | 1.98 (2.40) | 15.38 | 5.77 | 41 | 3.54 (2.38) | 34.15 | 9.76 | 40 | 1.63 (1.85) | 12.5 | 0 |
Nausea * | 51 | 0.35 (1.25) | 1.92 | 1.92 | 41 | 1.37 (2.22) | 9.76 | 7.32 | 40 | 0.43 (1.43) | 2.5 | 2.5 |
Disturbed Sleep | 51 | 2.45 (3.01) | 28.85 | 13.46 | 41 | 3.54 (3.09) | 31.71 | 21.95 | 40 | 1.78 (2.12) | 15 | 2.5 |
Distress | 52 | 1.83 (2.17) | 15.38 | 5.77 | 41 | 2.10 (2.31) | 21.95 | 4.88 | 40 | 1.20 (1.84) | 10 | 2.5 |
Shortness of Breath | 52 | 0.71 (1.40) | 1.92 | 1.92 | 41 | 1.02 (1.60) | 7.32 | 0 | 40 | 0.75 (1.63) | 5 | 2.5 |
Difficulty Remembering | 52 | 1.27 (1.73) | 3.85 | 1.92 | 41 | 1.41 (2.40) | 14.63 | 7.32 | 40 | 1.08 (1.59) | 2.5 | 0 |
Lack of Appetite * | 51 | 0.88 (1.44) | 5.77 | 0 | 41 | 3.66 (2.79) | 41.46 | 17.07 | 40 | 0.93 (1.61) | 5 | 0 |
Drowsiness * | 52 | 1.60 (2.36) | 13.46 | 5.77 | 41 | 3.56 (2.66) | 34.15 | 9.76 | 40 | 1.18 (1.41) | 2.5 | 0 |
Dry Mouth * | 52 | 1.13 (2.11) | 11.54 | 3.85 | 41 | 2.80 (2.97( | 24.39 | 14.63 | 40 | 0.73 (1.15) | 2.5 | 0 |
Sadness | 52 | 1.42 (2.15) | 15.38 | 1.92 | 41 | 1.83 (2.57) | 19.51 | 7.32 | 40 | 1.10 (1.58) | 2.5 | 2.5 |
Vomiting | 52 | 0.19 (0.99) | 1.92 | 1.92 | 41 | 0.44 (1.38) | 4.88 | 2.44 | 40 | 0.08 (0.27) | 0 | 0 |
Numbness | 52 | 1.02 (1.84) | 5.77 | 3.85 | 41 | 0.90 (1.61) | 7.32 | 0 | 40 | 1.00 (1.72) | 1 | 0 |
MDASI-PeriOpBLC Module Items | ||||||||||||
Blood in Your Urine † | 52 | 0.96 (2.42) | 7.69 | 5.77 | 37 | 1.57 (2.57) | 17.07 | 7.32 | 39 | 0.08 (0.27) | 0 | 0 |
Frequent Urination *,† | 52 | 2.83 (2.99) | 25 | 13.46 | 36 | 0.50 (1.46) | 7.32 | 0 | 39 | 0.51 (1.43) | 5 | 0 |
Leaking Urine *,† | 52 | 1.44 (2.81) | 13.46 | 11.54 | 36 | 0.47 (1.44) | 4.88 | 0 | 39 | 0.44 (0.94) | 0 | 0 |
Pain or Burning with Urination *,† | 52 | 0.85 (1.66) | 7.69 | 0 | 36 | 0.03 (0.17) | 0 | 0 | 38 | 0.03 (0.16) | 0 | 0 |
Urinary Urgency *,† | 52 | 2.42 (2.97) | 23.08 | 11.54 | 36 | 0.14 (0.54) | 0 | 0 | 39 | 0.49 (1.32) | 5 | 0 |
Constipation | 52 | 1.04 (1.97) | 7.69 | 1.92 | 41 | 1.90 (2.50) | 19.51 | 9.76 | 40 | 1.15 (1.83) | 12.5 | 0 |
Diarrhea * | 52 | 0.56 (1.61) | 3.85 | 1.92 | 40 | 1.83 (3.04) | 17.07 | 12.2 | 40 | 0.40 (1.41) | 2.5 | 0 |
Bloating/Abdominal Tightness *,† | 51 | 0.33 (0.99) | 1.92 | 0 | 41 | 3.10 (2.64) | 24.39 | 12.2 | 39 | 1.23 (1.72) | 7.5 | 0 |
Stomal Problems | 51 | 0.25 (0.87) | 1.92 | 0 | 40 | 0.63 (1.21) | 2.44 | 0 | 40 | 0.35 (0.66) | 0 | 0 |
MDASI-Interference Items | ||||||||||||
Walking * | 52 | 1.17 (2.26) | 9.62 | 5.77 | 40 | 3.13 (2.67) | 31.71 | 12.2 | 40 | 1.45 (1.97) | 10 | 2.5 |
General Activity * | 52 | 2.19 (3.32) | 23.08 | 17.31 | 41 | 5.49 (3.3) | 60.98 | 43.9 | 40 | 2.10 (2.28) | 22.5 | 5 |
Working * | 52 | 1.58 (2.64) | 19.23 | 5.77 | 40 | 5.00 (4.19) | 51.22 | 48.78 | 40 | 2.20 (2.21) | 15 | 5 |
Relations with Others * | 52 | 0.88 (2.05) | 9.62 | 1.92 | 41 | 2.02 (2.44) | 19.51 | 7.32 | 40 | 0.93 (1.53) | 7.5 | 0 |
Enjoyment of Life * | 52 | 1.73 (2.47) | 19.23 | 3.85 | 41 | 3.80 (3.44) | 41.46 | 26.83 | 40 | 1.88 (2.22) | 17.5 | 5 |
Mood * | 51 | 1.76 (2.45) | 15.38 | 5.77 | 40 | 2.90 (2.82) | 29.27 | 12.2 | 40 | 1.40 (1.75) | 15 | 0 |
MDASI Composite Scores | ||||||||||||
Core * | 52 | 1.20 (1.16) | 0 | 0 | 41 | 2.28 (1.51) | 7.32 | 0 | 40 | 1.02 (1.02) | 0 | 0 |
Module † | 52 | 1.19 (1.49) | 1.92 | 0 | 41 | 1.30 (1.19) | 2.44 | 0 | 40 | 0.52 (0.59) | 0 | 0 |
Interference * | 52 | 1.56 (2.23) | 11.54 | 3.85 | 41 | 3.73 (2.47) | 36.59 | 14.63 | 40 | 1.66 (1.64) | 7.5 | 0 |
WAW * | 52 | 1.65 (2.51) | 15.38 | 5.77 | 41 | 4.59 (2.94) | 53.66 | 24.39 | 40 | 1.92 (1.85) | 5 | 0 |
REM * | 52 | 1.46 (2.11) | 9.62 | 1.92 | 41 | 2.89 (2.45) | 21.95 | 9.76 | 40 | 1.40 (1.67) | 10 | 0 |
Most severe 6 Symptoms at Baseline † | 52 | 2.22 (2.14) | 13.46 | 5.77 | 41 | 2.17 (1.61) | 7.32 | 0 | 40 | 1.07 (1.26) | 0 | 0 |
Most severe 6 Symptoms at Discharge * | 52 | 1.34 (1.41) | 1.92 | 0 | 41 | 3.48 (2.11) | 24.39 | 4.88 | 40 | 1.36 (1.43) | 2.50 | 0 |
Outcomes on MDASI | Effect | Odds Ratio | 95% CI | p-Value |
---|---|---|---|---|
High vs. Low membership of total Interference Composite | Severity of Top 6 Baseline Composite a (0–10 scale) | 1.661 | 1.039–2.655 | 0.0339 |
CCI (>2 vs. ≤2) | 0.353 | 0.056–2.246 | 0.2701 | |
Age (≥65 vs. <65) | 1.504 | 0.244–9.255 | 0.6600 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 1.598 | 0.410–6.235 | 0.4998 | |
High vs. Low membership of total Interference Composite | Severity of Top 6 Discharge Composite b (0–10 scale) | 1.697 | 1.114–2.584 | 0.0137 |
CCI (>2 vs. ≤2) | 1.369 | 0.157–11.960 | 0.7766 | |
Age (≥65 vs. <65) | 0.564 | 0.064–4.939 | 0.6052 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 1.233 | 0.272–5.596 | 0.7863 | |
High vs. Low membership of WAW c Composite | Top 6 Baseline Composite a | 1.494 | 1.001–2.230 | 0.0494 |
CCI (>2 vs. ≤2) | 0.148 | 0.023–0.940 | 0.0428 | |
Age (≥65 vs. <65) | 1.858 | 0.316–10.909 | 0.4928 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 1.102 | 0.282–4.302 | 0.8891 | |
High vs. Low membership of WAW c Composite | Top 6 Discharge Composite b | 1.654 | 1.093–2.503 | 0.0172 |
CCI (>2 vs. ≤2) | 0.316 | 0.043–2.336 | 0.2592 | |
Age (≥65 vs. <65) | 0.839 | 0.117–6.032 | 0.8611 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 0.628 | 0.130–3.036 | 0.5631 | |
High vs. Low membership of REM d Composite | Severity of Top 6 Baseline Composite a (0–10 scale) | 1.617 | 1.025–2.552 | 0.0388 |
CCI (>2 vs. ≤2) | 0.451 | 0.076–2.691 | 0.3822 | |
Age (≥65 vs. <65) | 1.864 | 0.323–10.744 | 0.4861 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 1.044 | 0.266–4.092 | 0.9511 | |
High vs. Low membership of REM d Composite | Severity of Top 6 Discharge Composite b (0–10 scale) | 1.573 | 1.061–2.331 | 0.0242 |
CCI (>2 vs. ≤2) | 1.681 | 0.219–12.883 | 0.6171 | |
Age (≥65 vs. <65) | 0.726 | 0.095–5.553 | 0.7577 | |
Received Neoadjuvant Chemotherapy (Yes vs. No) | 0.799 | 0.181–3.534 | 0.7676 |
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Wang, X.S.; Bree, K.K.; Navai, N.; Kamal, M.; Shen, S.-E.; Letona, E.; Cleeland, C.S.; Shi, Q.; Gottumukkala, V. Utility of Patient-Reported Symptom and Functional Outcomes to Indicate Recovery after First 90 Days of Radical Cystectomy: A Longitudinal Study. Cancers 2023, 15, 3051. https://doi.org/10.3390/cancers15113051
Wang XS, Bree KK, Navai N, Kamal M, Shen S-E, Letona E, Cleeland CS, Shi Q, Gottumukkala V. Utility of Patient-Reported Symptom and Functional Outcomes to Indicate Recovery after First 90 Days of Radical Cystectomy: A Longitudinal Study. Cancers. 2023; 15(11):3051. https://doi.org/10.3390/cancers15113051
Chicago/Turabian StyleWang, Xin Shelley, Kelly K. Bree, Neema Navai, Mona Kamal, Shu-En Shen, Elizabeth Letona, Charles S. Cleeland, Qiuling Shi, and Vijaya Gottumukkala. 2023. "Utility of Patient-Reported Symptom and Functional Outcomes to Indicate Recovery after First 90 Days of Radical Cystectomy: A Longitudinal Study" Cancers 15, no. 11: 3051. https://doi.org/10.3390/cancers15113051