Patient-Reported Quality of Life and Convalescence After Minimally Invasive Kidney Cancer Surgery

Impact of Partial Nephrectomy and Percutaneous Cryoablation on Short-term Health-related Quality of Life—A Prospective Comparative Cohort Study

Background

Partial nephrectomy (PN) is the gold standard for the treatment of stage cT1 renal cell carcinoma (RCC). However, the increasing incidence of RCC in the elderly population calls for alternative minimally invasive treatments to reduce the negative effects on patients’ health-related quality of life (HRQoL) and subsequent healthy life expectancy.

Objective

To assess and compare short-term HRQoL and self-reported health status after PN and percutaneous cryoablation (PCA) of patients treated for RCC stage cT1.

Design, setting, and participants

Patients who underwent PN or PCA between 2019 and 2021 for RCC stage cT1 at two university hospitals in Denmark were assessed. The exclusion criteria included insufficient understanding of the Danish language, dementia, metastatic RCC, conversion to nephrectomy, and salvage procedures.

Intervention

PN and PCA.

Outcome measurements and statistical analysis

The European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire was distributed before treatment, and 14 and 90 d postoperatively. A linear mixed-effect model was used to analyze the changes from baseline to follow-up between PN and PCA treatment.

Results and limitations

The cohort included 165 patients (PN: 79; PCA: 86). The completion rate was 96–98%. Patients receiving PCA were significantly older (median 69.1 vs 62.1 yr) and had lower scores on physical (p < 0.001) and role functioning (p = 0.009) than PN. A statistically significant change from baseline to 14 d was found for several HRQoL scales, which favored PCA over PN. However, the observed change was no longer significant at 90-d follow-up. Limitations include sample size and confounding by indication.

Conclusions

This study found a significant difference between baseline and 14-d follow-up in several HRQoL and symptoms scales, favoring PCA over PN. However, no significant differences were observed in any HRQoL scales between PN and PCA of RCC stage cT1 from baseline to 90-d follow-up.

Patient summary

Surgical removal and percutaneous cryoablation (freezing) of small tumors in the kidney had a similar impact on quality of life after 90 d.

Assessing the impact of socio-economic determinants on access to care, surgical treatment options and outcomes among patients with renal mass: Insight from the universal healthcare system

OBJECTIVE

To assess whether socio-economic disparities exist on access to care, treatment options and outcomes among patients with renal mass amenable of surgical treatment within the universal healthcare system.

METHODS

Data of consecutive patients submitted to partial nephrectomy (PN) or radical nephrectomy (RN) at our Institution between 2017 and 2020 were retrospectively evaluated. Patients were grouped according to their income level (low, intermediate, and high) based on the Indicator of Equivalent Economic Situation national criterion. Survival analysis was performed. Cox regression models were employed to analyse the impact of socio-economic variables on survival outcomes.

RESULTS

One thousand forty-two patients were included (841 PN and 201 RN). Patients at the lowest income level were found more likely symptomatic and with a higher pathological tumour stage in the RN cohort (p > 0.05). The guidelines adherence on surgical indication rate as well as the access to minimally invasive surgery did not differ according to patient's income level in both cohorts (p > 0.05). Survival curves were comparable among the groups. Cox regression analysis showed that none of the included socio-economic variables was associated with survival outcomes in our series.

CONCLUSIONS

Universal healthcare system may increase the possibility to ensure egalitarian treatment modalities for patients with renal cancer.

Emotional state and cancer-related self-efficacy as affecting resilience and quality of life in kidney cancer patients: a cross-sectional study

OBJECTIVE

To assess the relationship between resilience and quality of life (QOL) of kidney cancer patients, including influencing factors.

METHODS

Based on a cross-sectional study design, participants (N = 103) were recruited from patients who were admitted to the urology clinic of a medical center in Taiwan between April 2020 and January 2021. Data collection was accomplished via a questionnaire. The study variables included demographic information, disease attributes, happiness level, depression, cancer-related self-efficacy, resilience, and QOL. One-way analysis of variance, Pearson correlation coefficients, independent-sample t-tests, hierarchical regression, and process analysis were the statistical methods used to analyze the data.

RESULTS

Kidney cancer patients who were less depressed exhibited better cancer-related self-efficacy and have better resilience. In non-depressed individuals, higher levels of happiness and better resilience resulted in better QOL. Resilience is a mediator that affects the relationship between depression and QOL.

CONCLUSIONS

Patients with better emotional state experience better resilience and QOL. Patients' better cancer-related self-efficacy is related to better resilience while better resilience is associated with better QOL. Clinical care providers need to evaluate and improve cancer-related self-efficacy, emotional state, and resilience of kidney cancer patients, which will improve their resilience and QOL.

Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

Purpose

To validate a German translation of the convalescence and recovery evaluation (CARE) as an electronic patient-reported outcome measure (ePROM) and use it to assess recovery after major urological surgery.

Methods

The CARE questionnaire was provided to patients scheduled for major urological surgery preoperatively, at discharge and 6 weeks postoperatively, using an ePROM system. Cronbach’s alpha, inter-scale correlations and confirmatory factor analysis (CFA) were used to validate the translation. Mixed linear regression models were used to identify factors influencing CARE results, and a multivariable logistic regression analysis was done to determine the predictive value of CARE results on quality of life (QoL).

Results

A total of 283 patients undergoing prostatectomy (n = 146, 51%), partial/radical nephrectomy (n = 70, 25%) or cystectomy (n = 67, 24%) responded to the survey. Internal consistency was high (α = 0.649–0.920) and the CFA showed a factor loading > 0.5 in 17/27 items. Significant main effects were found for the time of survey and type of surgery, while a time by type interaction was only found for the gastrointestinal subscale (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 30.37, p < 0.0001) and the total CARE score (TCS) (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 13.47, p = 0.009) for cystectomy patients, meaning a greater score decrease at discharge and lower level of recovery at follow-up. Complications demonstrated a significant negative effect on the TCS (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi_{(2)}^{2}$$\end{document}χ(2)2 = 8.61, p = 0.014). A high TCS at discharge was an independent predictor of a high QLQ-C30 QoL score at follow-up (OR = 5.26, 95%-CI 1.42–19.37, p = 0.013).

Conclusion

This German translation of the CARE can serve as a valid ePROM to measure recovery and predict QoL after major urological surgery.