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