Health-related quality of life among elderly Americans diagnosed with upper tract urothelial carcinoma

Background

Health-related quality of life (HRQOL) among elderly Americans diagnosed with upper tract urothelial cancer (UTUC) is unknown. We compared HRQOL in patients from before and after UTUC diagnosis and among different tumor stages after UTUC diagnosis using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey database.

Materials and Methods

This cross-sectional study used the 14 cohorts (1998–2013) of Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey to identify elderly Americans (≥65years) diagnosed with UTUC and with completed HRQOL surveys (the Short Form-36 or Veterans Rand-12). Patient surveys were grouped into pre- (Group A) and postdiagnosis (Group B) surveys. HRQOL was reported as least squares means of the physical component summary (PCS), mental component summary (MCS), and 8 subscales, adjusted for covariates. HRQOL least squares means-differences were estimated from separate multivariable regression models. Bonferroni correction was used for multiple comparisons on subscales.

Results

Qualifying patients were identified (n?=?408; Group A?=?177; Group B?=?231). Mean PCS and MCS were similar between the 2 groups. However, Group B had significantly worse HRQOL outcomes on general health (P = 0.015), vitality (P?=?0.016), and social functioning (P?=?0.003) subscales, compared to Group A. Mean MCS was the lowest within 1 year of diagnosis (P < 0.001), compared to patients with >1 year before diagnosis, but mean PCS did not change. Mean PCS and MCS were similar across UTUC stages.

Conclusions

UTUC affected some aspects of patients’ HRQOL. Most significant decline in mental health was within 1 year of diagnosis. HRQOL measures were not different among different stages. Attention to and provision of remedy to these HRQOL deficits are warranted.