Comprehensive Assessment of Quality of Life and Psychosocial Adjustment in Patients With Renal Tumors Undergoing Open, Laparoscopic and Nephron Sparing Surgery

Abstract

Purpose We prospectively evaluated the general and cancer-specific quality of life (QOL) and psychosocial adjustment of patients with a renal mass who underwent radical versus partial nephrectomy performed by laparoscopic or open approaches. Materials and Methods 172 patients with renal tumors completed questionnaires before surgery and again at 3 weeks, 2, 3, 6, and 12 months post-surgery. We assessed general QOL (SF-36), cancer-specific-QOL (CARES-SF), intrusive thoughts and avoidance behaviors, and fear of recurrence. We used mixed model regression analyses to compare these measures across surgery types over the course of the study and adjusted for tumor size, histology, stage and renal function. Results The physical component score of the SF-36 different significantly by surgery type over time (p = 0.04). Patients who had laparoscopy improved by month 2 whereas those who had open surgery had poorer QOL until month 3. Better cancer-specific QOL was reported in patients undergoing radical versus partial nephrectomy. Age also had significant effects on outcomes. Conclusions We report on one of the most comprehensive patient-reported prospective QOL studies in RCC patients. There were significant differences in QOL and psychosocial adjustment outcomes over the course of one year among patients who had one of four commonly accepted surgical renal procedures, and we show that these outcomes must be evaluated in the context of tumor characteristics, cancer-specific outcomes and renal function. These QOL issues may be important to consider when choosing surgical procedures for patients with renal tumors.

Health-related quality of life in long-term survivors after renal cancer treatment

“…NSS versus RN, and the surgical access is just an incidental factor [9,22]. The present study shows that NSS, associated with flank surgery, predicts higher GFR.…”

Illness Uncertainty and Quality of Life of Patients with Small Renal Tumors Undergoing Watchful Waiting: A 2-year Prospective Study

“…We recently showed, in one of the most comprehensive and largest QOL studies with patients undergoing different types of surgery for a renal mass (open radical, open partial, laparoscopic radical, or laparoscopic partial nephrectomy) who were assessed for 1 yr following surgery, that age had a great effect on how patients experience treatment of their cancer: Younger patients reported significantly less worry but more intrusive thoughts and behaviors [6]. In that study, we also found that all the physical benefits of a minimally invasive approach dissolved by 3 mo, while anxiety and worry over recurrence of cancer remained prominent 1 yr after surgery.…”

“…In the spectrum of treatment options for small renal masses, WW represents the ultimate noninvasive and nephron-sparing approach. Recent prospective data have shown that age, renal function preservation, and tumor-related criteria (ie, size and pathologic stage) are independent predictors of quality of life (QOL) for patients undergoing surgical intervention for a renal mass [6]. In contrast, there appears to be little or no information on patient-derived outcomes for patients with a renal mass who are undergoing WW.…”

Is radical nephrectomy a legitimate therapeutic option in patients with renal masses amenable to nephron‐sparing surgery?

“…Among patients treated with open PN or RN, there were no QoL differences 1 year after surgery, but renal functional preservation was noted to have a measurable patient‐reported QoL benefit . Comparatively, patients undergoing laparoscopic RN or PN have measurable short‐term patient‐reported QoL benefits, but the differences disappear after a few months ; however, patient fear of cancer and its recurrence, especially among older patients, remains an important factor at 1 year . Treatment options for localised RCC, therefore, have potential QoL implications, which merit consideration during treatment selection.…”