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

Purpose

We prospectively evaluated the general and cancer specific quality of life, and psychosocial adjustment of patients with a renal mass treated with radical vs partial nephrectomy via a laparoscopic or an open approach.

Materials and Methods

A total of 172 patients with renal tumors completed questionnaires before surgery, and 3 weeks, and 2, 3, 6 and 12 months postoperatively. We assessed general quality of life using SF-36™ and cancer specific quality of life using the Cancer Rehabilitation Evaluation System-Short Form, in addition to intrusive thoughts, avoidance behaviors and fear of recurrence. We used mixed model regression analysis to compare these measures across surgery types during the study course, adjusted for tumor size, histology, stage and renal function.

Results

The SF-36 physical component score differed significantly by surgery type with time (p = 0.04). Patients treated with laparoscopy improved by month 2 while those treated with open surgery had poorer quality of life until month 3. Better cancer specific quality of life was reported in patients who underwent radical vs partial nephrectomy. Age also had a significant effect on outcomes.

Conclusions

We report one of the most comprehensive patient reported prospective quality of life studies in patients with renal cell carcinoma. There were significant differences in quality of life and psychosocial adjustment outcomes during 1 year among patients treated with 1 of 4 commonly accepted surgical renal procedures. These outcomes must be evaluated in the context of tumor characteristics, cancer specific outcomes and renal function. These quality of life issues may be important to consider when choosing surgical procedures for patients with renal tumors.

Key Words:  kidney , carcinoma , renal cell , quality of life , questionnaires , psychology

Abbreviations and Acronyms:  CARES-SF, Cancer Rehabilitation Evaluation System-Short Form, GFR, glomerular filtration rate, IES, Impact of Event Scale, LP, laparoscopic partial nephrectomy, LR, laparoscopic radical nephrectomy, MCS, Mental Component Summary, OP, partial open nephrectomy, OR, radical open nephrectomy, PCS, Physical Component Summary, QOL, quality of life, RCC, renal cell carcinoma