Quality of Life assessment in Urology



As medicine shifts away from measuring success of treatments purely on increased survival chance, an increase in patient’s quality of life (QoL) has become a better metric to judge a procedure, device or therapeutics efficacy [1]. The 4 main areas feeding in to identifying QoL: physical health, societal health, functional health and psychological health [2]. In urology specifically a number of different factors can affect a patient’s QoL, such as: pain, continence, urgency, infection rate and social impact [2].


Several tools have been created and qualified to determine the factors which patient most value. Some of these are generic tools which can be applied to an assessment of the QoL of patients with any medical condition.


Tools like this include:


Due to the variation in experience between different urological conditions it is preferred to use a specific questionnaire due to increased patient comprehension and detail. For example, for urological cancer patients it is advised to use a generic QoL questionnaire, followed by a cancer specific questionnaire and then a cancer site specific questionnaire [2]. Many of these existing tools are not entirely comparable to each other. It is also important to note that there will be cultural weight to certain factors between surveys conducted in different countries and so these results cannot be compared universally.


There are more specific tools which address certain conditions and treatments. One such tool is the Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC) [3, 4]. This tool assesses 29 symptoms associated with intermittent catheterisation identified from patients in clinical practice. As Neuropathic bladder is a condition which can vary greatly between patients the tool assesses symptom experience to determine what future interventions could be performed by healthcare professionals in the community. Another example of a condition specific tool in urology would be OAB-q for assessment of QoL in overactive bladder (OAB) patients in form of a 25 item symptom severity questionnaire [5]. The OAB-q responses analysed in respect to the therapeutics used for OAB management such as oral antimuscarinics.


A systematic review of QoL in bladder cancer patients gave some insight into the weight patients put on aspects of their condition. All patients who received chemotherapy reported an increased QoL [6]. In comparative groups it was found that sexual dysfunction led to a greater decrease in QoL compared to haematuria [6]. Urinary function was also found to be one of the most impactful. With these identified factors further research needs to be done into the psychosocial aspects of bladder cancer on patients. Due to the differences between treatments more specific tools differentiating between patients receiving chemotherapy and radiotherapy.


Multiple studies have linked urinary incontinence (UI) to a decrease in QoL of female patients [7]. UI not only affects a woman’s physical well-being, but also has a significant impact on the psychological and socioeconomic aspects of a woman’s life. QoL studies have shown that healthcare professionals inclusion in patients treatment with an intermittent catheter leads to improved QoL and improved compliance [8]. This is attributed to an increased long term patient independence with the procedure [8].


Currently several specific tools have been developed to assess QoL of patients with urological conditions. Thus, a variety of different tools should be used in assessment of the patient’s general QoL, condition specific QoL and QoL in respect to the administered treatment(s).



References:

1. Drummond, M., Introducing economic and quality of life measurements into clinical studies. Ann Med, 2001. 33: p. 344-349.

2. Macdonagh, R., Quality of life and its assessment in urology. British Journal of Urology 1996. 78: p. 485-496.

3. Bermingham, S.L. and J.F. Ashe, Systematic review of the impact of urinary tract infections on health-related quality of life. BJU Int, 2012. 110(11 Pt C): p. E830-6.

4. Tractenberg, R.E., et al., Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC): A patient-centered patient reported outcome. PLoS One, 2018. 13(7): p. e0197568.

5. Johnston, K.M., D.R. Walker, and P. Lakzadeh, Characterizing the Health-Related Quality of Life Burden of Overactive Bladder Using Disease-Specific Patient-Reported Outcome Measures: A Systematic Literature Review. Adv Ther, 2019. 36(3): p. 548-562.

6. Taarnhoj, G.A., C. Johansen, and H. Pappot, Quality of life in bladder cancer patients receiving medical oncological treatment; a systematic review of the literature. Health Qual Life Outcomes, 2019. 17(1): p. 20.

7. Kwon, B.E., et al., Quality of life of women with urinary incontinence: a systematic literature review. Int Neurourol J, 2010. 14(3): p. 133-8.

8. Fumincelli, L., et al., Quality of life of patients using intermittent urinary catheterization. Rev. Latino-Am. Enfermagem, 2017. 25.




Bibliography

Penson, D. F., & Litwin, M. S. (1997). Quality of life assessment in urology.Contemporary Urology,9, 53-66.


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