Elsevier

European Urology

Volume 57, Issue 1, January 2010, Pages 112-122
European Urology

Kidney Cancer
Factors Predicting Health-Related Quality of Life Recovery in Patients Undergoing Surgical Treatment for Renal Tumors: Prospective Evaluation Using the RAND SF-36 Health Survey

https://doi.org/10.1016/j.eururo.2009.04.023Get rights and content

Abstract

Background

Most newly diagnosed kidney cancers present at localized stages. With appropriate treatments, the cancer-specific survival rates of such patients are extremely high, which makes patients’ health-related quality of life (HRQoL) a relevant issue. To date, most of the available studies on HRQoL have been biased by the absence of baseline HRQoL assessments and by retrospective designs.

Objective

To evaluate the baseline HRQoL of patients with kidney cancer, comparative HRQoL during the first year after surgery, and the prognostic factors predictive of HRQoL recovery.

Design, setting, and participants

We prospectively collected the data of all patients undergoing surgery for kidney tumors at a tertiary academic referral center from February 2006 to September 2007.

Interventions

Patients underwent nephron-sparing surgery (NSS) or radical nephrectomy (RN).

Measurements

Patients were invited to self-complete the validated, Italian version of the RAND 36-Item Health Survey 1.0 (SF-36) before surgery, 6 mo after surgery, and 12 mo after surgery.

Results and limitations

Overall, 129 consecutive patients were evaluated. No significant differences were found between the baseline scores of our patients and age- and sex-matched normative data for the Italian general population. Comparing the baseline SF-36 scores to those at 6 mo and 12 mo, there was statistically significant worsening in the physical domains and improvement in the emotional domains (all p < 0.05). About 50–80% of patients returned to baseline scores 6 mo and 12 mo after surgery. Age, body mass index (BMI), educational level, occupational status, New York Heart Association (NYHA) functional class, tumor mode of presentation, pathologic stage, size, and histologic subtype were associated with 6-mo and 12-mo return to the baseline HRQoL scores. The main limitation of the study was the lack of a disease-specific questionnaire.

Conclusions

Most patients returned to preoperative HRQoL within 12 mo after RN or NSS. Several patient features, clinical variables, and pathologic tumor variables predict the return of HRQoL.

Introduction

An estimated 54 000 new cases of kidney cancer were diagnosed in the United States in 2008 [1]. Similarly, about 64 000 new cases were diagnosed in Europe in 2006 [2]. However, a great proportion of newly diagnosed patients currently present with stage I tumors, incidentally detected cancer [3] that can be treated appropriately by elective partial or radical nephrectomy (RN), yielding extremely high cancer-specific survival rates.

The World Health Organization defines quality of life as an “individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” [4]. Consequently, quality of life is a multidimensional, broad-ranging concept comprising individuals’ perceived physical, psychosocial, and emotional functioning, which is affected by their physical health, psychological state, level of independence, social relationships, and their relationship to the salient features of their environment. Specifically, health-related quality of life (HRQoL) is the extent to which one’s usual or expected physical, emotional, and social well-being are affected by a medical condition or its treatment [5].

Due to the multidimensional nature of HRQoL and the complexity of measuring it, a large spectrum of questionnaires and scales have been developed, including generic and disease-specific questionnaires, and even scales specific for different cancer sites [6].

Few authors have reported HRQoL after surgical treatment of kidney tumors [7], [8], [9], [10], [11], [12], [13]. However, most studies have been biased by several issues, including absence of a baseline HRQoL assessment, cross-sectional design [7], [8], [9], [10], [11], [12], [13], small number of enrolled patients [10], [13], and low response rates [10], [11]. Consequently, factors affecting the baseline HRQoL of patients with renal tumors have not been evaluated, and the time needed to return to baseline HRQoL after treatment and prognostic factors predictive of the return to the preoperative HRQoL are mostly unknown. To date, HRQoL issues have had only a marginal impact on the decision-making process of those patients with kidney tumors.

The present study had the following objectives: (1) to prospectively evaluate the baseline HRQoL of patients with kidney tumors in comparison to the healthy population, (2) to evaluate changes in HRQoL during the first 12 mo after nephron-sparing surgery (NSS) or RN, and (3) to evaluate the factors predictive of the return of HRQoL.

Section snippets

Materials and methods

From February 2006 to September 2007, all patients undergoing NSS or RN for kidney tumor in our department were invited to participate in this study.

All cases were preoperatively staged as recommended by European Association of Urology (EAU) guidelines [14]. Eastern Cooperative Oncology Group (ECOG) classification [15], Charlson comorbidity index [16], [17], and New York Heart Association (NYHA) classification [18] were used to assess the performance status, cardiovascular risk, and comorbidity

Results

Overall, 168 patients had surgery for kidney tumors during the evaluation period; 151 (90%) decided to participate, while 17 (10%) refused. Twenty-two of the 151 patients (15%) were excluded from the present analysis because of the lack of the follow-up questionnaires. The responses of the remaining 129 patients (85%) who completed the 6-mo and 12-mo questionnaires were evaluated. The clinical and pathologic characteristics of the patients who responded and who did not were significantly

Discussion

The data from our prospective study suggest that, although baseline scores were similar to those of the normative data from the age- and sex-matched Italian general population, significant modifications of the HRQoL as expressed by the SF-36 scores occurred during the first year after surgical treatment for renal neoplasm. Specifically, the scores in some domains concerning physical function (such as PF, RP, and BP) indicated a worsening of patients’ HRQoL, while an improvement was observed in

Conclusions

Although baseline scores were similar to normative data from the age- and sex-matched Italian general population, we observed significant modifications of the HRQoL as expressed by the SF-36 scores during the first year after surgical treatment for renal neoplasm. At 6 mo and 12 mo after surgery, 19–51% of patients did not achieve scores comparable to the baseline values. Mode of presentation, stage of the primary tumor, tumor size, histologic tumor type, and some of the clinical features of

References (27)

  • The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization....
  • D. Khanna et al.

    Health-related quality of life-an introduction

    Am J Manag Care

    (2007)
  • C. McCabe et al.

    Methodological issues related to assessing and measuring quality of life in patients with cancer: implications for patient care

    Eur J Cancer Care (Engl)

    (2008)
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