Return to work improves quality of life and reduces psychosocial distress after radical cystectomy – data from a contemporary series of 230 German Patients

Abstract

Abstract Purpose: This study aims to evaluate health-related quality of life (HRQoL), psychosocial distress, and return to work (RTW) two years after radical cystectomy (RC) and inpatient rehabilitation (IR). Material and Methods: The study relied on prospectively collected data for 842 patients, who underwent three weeks of IR after RC and creation of an ileal conduit (IC) or ileal neobladder (INB). Validated questionnaires surveyed patients on HRQoL and psychosocial distress (EORTC QLQ-C30, QSC-R10). Furthermore, employment status was evaluated. Regression was performed to identify predictors for HRQol, psychosocial distress, and RTW. Results: Two-hundred and thirty patients were employed pre-surgery (77.8% INB, 22.2% IC). Patients with an IC suffered significantly more often from locally advanced disease (≥pT3: 43.1% vs 22.9%; p=0.004). Two years after surgery, 16.1% of patients had died (median days of survival 302 (IQR 204-482). Global HRQoL improved steadily, while high psychosocial distress was present in 46.5% of patients two years after surgery. Employment was reported by 68.2% of patients, of which 90.3% worked full-time. Retirement was reported by 18.5%. Multivariate logistic regression analysis identified age ≤59 years as the only positive predictor for RTW two years after surgery (OR 7.730; 95% CI 3.369-17.736; p<0.001). Gender, surgical technique, tumor stage, and socioeconomic status did not influence RTW in this model. In multivariate linear regression analysis, RTW was identified as an independent predictor of better global HRQoL (p=0.018) and lower psychosocial distress (p<0.001), whereas younger patient age was identified as an independent predictor for higher psychosocial distress (p=0.002). Conclusion: Global HRQoL and RTW are high among patients two years after RC. However, role, emotional, cognitive, and social functioning were significantly impaired, while high psychosocial distress persists in a material number of patients. Implications for Cancer Survivors: Our study highlights, how a successful RTW decreases psychosocial distress and increases QoL in patients after RC for urothelial cancer. Nonetheless, additional efforts by employers and healthcare providers are needed in aftercare after creation of an INB or IC.