Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer

Bente Thoft Jensen, Susanne Vahr Lauridsen, Jørgen Bjerggaard Jensen, Bente Thoft Jensen, Susanne Vahr Lauridsen, Jørgen Bjerggaard Jensen

Abstract

Purpose of review: To identify components representing optimal delivery of follow-up care after radical cystectomy because of bladder cancer and report the current level of evidence.

Methods: We conducted a systematic literature search of the following databases: Cochrane, MEDLINE, Embase, CINAHL, Web of Science, Physiotherapy Evidence Database and ClinicalTrials.gov. The search results were managed in Covidence Reference Manager and abstracts were screened by title. Articles relevant to the subject of interest were included and the results are reported narratively.

Results: Several studies have evaluated the positive impact of enhanced recovery after surgery (ERAS) on length of stay, albeit not on the further impact on 90-day postoperative complication rate, functional recovery, or mortality. Minimally invasive surgery may result in a slighter shorter length of stay compared to open surgery. Physical training combined with nutritional intervention can improve functional recovery up to one year after surgery. Nutritional supplements can preserve muscle and bone mass, and potentially improve recovery. Patient education in stoma care and prevention of infection can significantly improve self-efficacy and avoid symptoms of infection postoperatively. Moreover, specific devices like applications (apps) can support these efforts. Continued smoking increases the risk of developing postoperative complications while no evidence was found on the impact of continued alcohol drinking. Currently, there is no evidence on psychological well-being, sexual health, or shared decision making interventions with an impact on rehabilitation after radical cystectomy.

Conclusion: Data are scarce but indicate that peri- and postoperative multi-professional interventions can reduce prevalence of sarcopenia, and improve functional recovery, physical capacity, nutritional status, and self-efficacy in stoma care (level 1 evidence). Continued smoking increases the risk of complications, but the effects of a smoking and alcohol intervention remain unclear (level 3 evidence). The results of this review provide guidance for future directions in research and further attempts to develop and test an evidence-based program for follow-up care after radical cystectomy.

Keywords: enhanced recovery; muscle invasive bladder cancer; radical cystectomy; recovery; rehabilitation; self-efficacy.

Conflict of interest statement

Prof. Dr. Jørgen Bjerggaard Jensen reports grants from Ferring, Photocure ASA, medac and Cephaid, and personal fees from Ferring, Olympus and Cephaid. He is proctor for Intuitive Surgery outside the submitted work. The authors have no other potential conflicts of interest to report for this work.

© 2020 Jensen et al.

Figures

Figure 1
Figure 1
The Bladder Cancer Pathway. * If the patient is not a qualified candidate for neo.adj. chemotherapy the next step will be surgery.
Figure 2
Figure 2
Prisma Flow-diagram - Optimal Follow-up Care after Radical Cystectomy.

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