Urinary Diversion Among Bladder Cancer Survivors: Cost, Complications, and QOL

膀胱癌幸存者的尿流改道：费用、并发症和生活质量

• 批准号: 8305362
• 负责人: CARMIT Kurn MCMULLEN
• 金额: $ 66.93万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-13 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8305362
• 关键词: Abdomen; Advanced Malignant Neoplasm; Affect; Age; Bladder; Bladder Control; Body Image; California; Cancer Patient; Cancer Survivor; Caregiver Burden; Caregivers; Characteristics; Clinical; Comorbidity; Computerized Medical Record; Costs and Benefits; Cystectomy; Data; Decision Making; Diagnosis; Durable Medical Equipment; Economics; Electronic Health Record; Eligibility Determination; Excision; Family; Family Caregiver; Family Physicians; Family member; Female; Gender; Generic Drugs; Goals; Health Planning; Healthcare; Ileal conduit procedure; Imaging Techniques; Incidence; Insurance; Integrated Delivery Systems; Intestines; Laboratories; Lead; Life; Long-Term Care; Malignant neoplasm of urinary bladder; Measures; Methods; Muscle; Neighborhoods; Operative Surgical Procedures; Outcome; Participant; Patient-Centered Care; Patients; Pharmaceutical Preparations; Procedures; Quality of life; Recruitment Activity; Rehabilitation therapy; Reliance; Reporting; Research; Skin; Subgroup; Surgeon; Surveys; Survivors; System; Teaching Hospitals; Testing; Uninsured Medical Expense; United States; Urethra; Urinary Diversion; Urine; Urologist; Urostomy; base; bladder surgery; cancer care; cancer surgery; cancer therapy; care giving burden; caregiving; cohort; community setting; comparative; comparative effectiveness; cost; demographics; disability; economic cost; economic impact; functional disability; health related quality of life; member; patient oriented; population based; productivity loss; reconstruction; satisfaction; urinary; urologic; virtual

DESCRIPTION (provided by applicant): Few studies have explored treatment-related disabilities among cancer survivors, yet for many survivors, surgical interventions have persistent effects on everyday life. In the case of muscle-invasive bladder cancer, surgery for cancer treatment involves removing the bladder. Each year 7,000 people with bladder cancer in the United States have cystectomy surgery (bladder removal). Portions of their bowel are used to create different types of urinary diversions, which are new conduits and reservoirs that create new ways for urine to be eliminated from the body. Urinary diversion (UD) reconstructions allow patients to pass urine by creating a new bladder (neobladder) that allows urine to flow through the urethra, or by creating an ileal conduit leading to an opening in the abdomen (urostomy). To date, research has not provided clear evidence to guide patients' and clinicians' decision-making about choosing between a neobladder or ileal conduit diversion. The choice has profound implications for cancer survivors and their families, and the long-term costs and complications of ileal conduit vs. neobladder diversions are unknown. This mixed-method, comparative effectiveness study will compare costs, complications, patient- and family- centered outcomes related to UD. Study participants will include bladder cancer patients undergoing cystectomy and their family caregivers within three Kaiser Permanente (KP) regions with a membership base of over six million enrollees. This population base, along with comprehensive electronic medical record data, form a unique opportunity to compare varied outcomes in a large, defined cohort of bladder cancer patients treated in integrated delivery systems. We will collect extensive data on a cohort of 1,500 bladder cancer patients with cystectomies and UD performed in 2010-2015. We will also recruit the subgroup of patients whose cystectomies are performed during 2013-2015, along with their family caregivers, for participation in two annual surveys to gather patient-centered, care giving and economic data. Our specific aims are: AIM 1: Determine the socio-demographic, clinical, and surgeon characteristics that predict UD choice among bladder cancer patients receiving cystectomies from 2010 through 2015 (N=1,500). (Approximately 20% will be neobladder patients.) AIM 2: Compare incremental health care expenses attributable to UD and the incidence of late UD-related complications (>90 days post-op) for patients with ileal conduits vs. neobladders (N=1,500). AIM 3: Determine the impacts of UD type on economic and patient- and family-centered outcomes, as collected in surveys of 375 patients and 178 family caregivers 5 and 17 months after UD surgery. PUBLIC HEALTH RELEVANCE: Each year over 7000 people in the US have their bladders removed due to bladder cancer. There are two different options for creating new ways to pass urine, but it is not clear which option is best. This study will follow bladder cancer patients for two years after their bladders are removed. We will compare the costs and complications associated with each option, and how each option affects patients and their families.

描述（由申请人提供）：很少有研究探讨癌症幸存者中与治疗相关的残疾，然而对于许多幸存者来说，手术干预对日常生活有持续的影响。在肌肉侵袭性膀胱癌的情况下，癌症治疗的手术包括切除膀胱。在美国，每年有7000名膀胱癌患者接受膀胱切除手术。它们的肠道部分被用来制造不同类型的尿分流，这是新的管道和储存库，为尿液从体内排出创造了新的途径。尿改道（UD）重建允许病人通过创造一个新的膀胱（新膀胱）来排出尿液，使尿液流经尿道，或者通过创造一个回肠导管在腹部打开（尿造口术）来排出尿液。到目前为止，研究还没有提供明确的证据来指导患者和临床医生在选择新膀胱或回肠导管转移之间做出决定。这种选择对癌症幸存者及其家属有着深远的影响，而回肠导管与新膀胱转移的长期成本和并发症尚不清楚。这项混合方法的比较有效性研究将比较与UD相关的费用、并发症、患者和家庭为中心的结果。研究参与者将包括三个Kaiser Permanente （KP）区域内接受膀胱切除术的膀胱癌患者及其家庭护理人员，会员基数超过600万。这一人口基数，以及综合的电子医疗记录数据，形成了一个独特的机会来比较在综合输送系统中治疗的膀胱癌患者的大型、明确队列的不同结果。我们将收集2010-2015年间1500例膀胱切除术和膀胱切除术的膀胱癌患者的广泛数据。我们还将招募2013-2015年期间进行膀胱切除术的患者亚组及其家庭护理人员参加两次年度调查，以收集以患者为中心的护理和经济数据。我们的具体目标是：目的1：确定2010年至2015年接受膀胱切除术的膀胱癌患者中预测UD选择的社会人口学、临床和外科医生特征（N= 1500）。（约20%为新膀胱患者。）目的2：比较回肠导管与新膀胱患者因UD而增加的医疗费用和晚期UD相关并发症（术后90天）的发生率（N= 1500）。目的3：根据对375名患者和178名家庭护理人员在UD手术后5个月和17个月的调查，确定UD类型对经济和以患者和家庭为中心的结果的影响。