A Comparative Analysis of Quality of Life of Patients Treated by Radical Cystectomy and Sigmoid Neobladder versus Chemoradiation in Muscle Invasive Cancer of Urinary Bladder

1
A Comparative Analysis of Quality of Life of
Patients Treated by Radical Cystectomy and
Sigmoid Neobladder versus Chemoradiation in
Muscle Invasive Cancer of Urinary Bladder
K. P. Haresh, P. K. Julka, R. Prabhakar, S.
Senthamilzelvan, A. Seth, G. K. Rath.
All India Institute of Medical Sciences, New
Delhi, India
2
PURPOSE

• Radical cystectomy (RC) and chemoradiation (CTRT)
  -the present standard treatment options for
  muscle invasive cancer of urinary bladder (UB)
• RC has got its own inherent psychosexual issues
  associated with urinary diversion
• The new technique of sigmoid neobladder (SNB)
  provide an artificial bladder fashioned out of
  sigmoid colon with the patient able to void
  through their natural urethra.
• The purpose of our study is to compare the QOL
  between RC with SNB vs. CTRT.

3
Material and Methods

• Prospective non-randomized study
• May 2001 to June 2005
• Transitional cell cancer of UB, T2 to T4, N0/N1,
  M0
• N 30
• A modified questionnaire from EORTC-QLQ and
  bladder symptom score -(Madsen and Iversen,
  1983).
• The patients were directly interviewed.
• QOL scores were recorded both before treatment
  and during follow up.

4
S.NO. QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE QUESTIONNAIRE SCORE
1. How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week? How much would you grade your overall physical health in the past week?
1. 0 10 10 20 20 25 25 25 30 30 40 40 50 50 50 60 60 70 70 75 80 80 90 100
1. Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 1 2 3 4
2. Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS Performance questionnaire KPS
Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no Were you symptomatic in last week? Yes/ no
Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no Did you need to put effort for your routine activities ? yes / no
Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no Were you able to work in past week ? Yes/ no
Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no Did you need any assistance ? yes / no
If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care If yes, the assistance type Occasional / Considerable / Special Care / Hospital Care
KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 KPS score 0 20 1, 21-50 2, 51-80 3, 81-100 4 1 2 3 4
3. How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week? How would you grade your mental well being in the past week?
3. 0 10 20 20 25 25 30 30 30 40 40 50 50 60 60 60 70 70 75 75 80 80 90 100
3. Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 Score till 251, 25-50 2, 50- 753, 75-1004 1 2 3 4
4. Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ? Is the disease / treatment interfering with your family life ?
4. No No No No No No No Minimal Minimal Minimal Minimal Minimal Minimal Moderate Moderate Moderate Moderate Moderate Moderate Moderate Moderate Very much Very much Very much
4. 4 4 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 2 2 1 1 1 1 2 3 4
5. Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life? Does the disease / treatment interfere with your social life?
5. No No No No No No No Minimal Minimal Minimal Minimal Minimal Minimal Minimal Moderate Moderate Moderate Moderate Moderate Moderate Moderate Very much Very much Very much
5. 4 4 4 4 4 4 4 3 3 3 3 3 3 3 2 2 2 2 2 2 2 1 1 1 1 2 3 4
6. Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ? Did you have any problem in going out to public ?
6. No No No No No No No Minimal Minimal Minimal Minimal Minimal Minimal Moderate Moderate Moderate Moderate Moderate Moderate Moderate Moderate Very much Very much Very much
6. 4 4 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 2 2 1 1 1 1 2 3 4
5
QUESTIONNAIRE contd
7. Did the disease / treatment interfere with your sexual life? Did the disease / treatment interfere with your sexual life? Did the disease / treatment interfere with your sexual life? Did the disease / treatment interfere with your sexual life?
7. No Minimal Moderate Very much
7. 4 3 2 1 1 2 3 4
8. Did the disease / treatment cause financial problems? Did the disease / treatment cause financial problems? Did the disease / treatment cause financial problems? Did the disease / treatment cause financial problems?
8. No Minimal Moderate Very much
8. 4 3 2 1 1 2 3 4
9. Did you suffer any complication due to treatment? Did you suffer any complication due to treatment? Did you suffer any complication due to treatment? Did you suffer any complication due to treatment?
9. No Minimal Moderate Very much
9. 4 3 2 1 1 2 3 4
10. Total inpatient hospital stay Total inpatient hospital stay Total inpatient hospital stay Total inpatient hospital stay
10. lt10 days 11-15 days 16-20 days gt 20 days
10. 4 3 2 1 1 2 3 4
11. How is your sleep in last 1 week ? How is your sleep in last 1 week ? How is your sleep in last 1 week ? How is your sleep in last 1 week ?
11. Normal Minimally altered Moderate insomnia Severe insomnia
11. 4 3 2 1 1 2 3 4
6
Bladder / rectal symptom score Did you have ? Bladder / rectal symptom score Did you have ? Bladder / rectal symptom score Did you have ? Bladder / rectal symptom score Did you have ? Bladder / rectal symptom score Did you have ? SCORE
12. Hematuria Hematuria Hematuria Hematuria Hematuria
12. Never Occasionally Occasionally Clots in urine Clot retention
12. 4 3 3 2 1 1 2 3 4
13. Frequency Frequency Frequency Frequency Frequency
13. gt3 h 2-3 h 1-2 h 1-2 h lt1 h
13. 4 3 2 2 1 1 2 3 4
14. Nocturia Nocturia Nocturia Nocturia Nocturia
14. 0-1x 2x 3-4x 3-4x gt4x
14. 4 3 2 2 1 1 2 3 4
15. Urgency Urgency Urgency Urgency Urgency
15. None Mild Moderate Moderate Severe
15. 4 3 2 2 1 1 2 3 4
16. Dysuria Dysuria Dysuria Dysuria Dysuria
16. Nil Occ. Burning Burning gt50 of time Burning gt50 of time Frequent and painful burning
16. 4 3 2 2 1 1 2 3 4
17. Diarrhoea Diarrhoea Diarrhoea Diarrhoea Diarrhoea
17. Nil Occasional Frequent Frequent With blood
17. 4 3 2 2 1 1 2 3 4
7

• The mean score (as percentage) was calculated for
  each observation in the two groups separately.
• Independent t test was performed with the initial
  individual sample values and the p value was
  obtained for inter group comparison.

8
RESULTS
Sx pre tmt vs CTRT pre tmt (p value) Sx pre tmt vs Sx post tmt (p value) CTRT pre tmt vs CTRT post tmt (p value) Sx post tmt vs CTRT post tmt (p value)
Physical health 90.00/84.61 (0.528) 90.00/86.46 (0.477) 84.61/90.28 (0.607) 84.46/90.28 (0.486)
Mental health 74.16/84.61 (0.175) 74.16/89.58 (0.013) 84.61/91.67 (0.059) 89.58/91.67 (0.525)
Family life 60.83/67.31 (0.516) 60.83/80.21 (0.051) 67.31/97.22 (0.020) 80.21/97.22 (0.041)
Social life 79.16/84.62 (0.585) 79.16/83.33 (0.438) 84.62/97.22 (0.102) 83.33/97.22 (0.128)
Public life 92.50/96.15 (0.821) 92.50/87.50 (0.336) 96.15/97.22 (0.564) 87.50/97.22 (0.350)
Sexual life 80.83/78.85 (0.953) 80.83/43.75 (0.001) 78.85/80.56 (1.000) 43.75/80.56 (0.008)
Financial 70.83/75.00 (0.725) 70.83/69.79 (0.603) 75.00/91.67 (0.071) 69.79/91.67 (0.051)
Sleep 85.83/88.46 (0.857) 85.83/94.79 (0.028) 88.46/100.00 (0.180) 94.79/100.00 (0.379)
Hematuria 54.16/55.77 (0.733) 54.16/100.00 (0.010) 55.77/97.22 (0.010) 100.00/97.22 (0.292)
Frequency 57.50/75.00 (0.076) 57.50/70.00 (0.429) 75.00/75.00 (0.863) 70.00/75.00 (0.422)
Nocturia 52.50/53.85 (0.934) 52.20/65.00 (0.589) 53.85/72.22 (0.058) 65.00/72.22 (0.496)
Urgency 83.33/84.62 (0.821) 83.33/80.00 (0.058) 84.62/97.22 (0.157) 80.00/97.22 (0.011)
Dysuria 76.66/88.46 (0.112) 76.66/100.00 (0.041) 88.46/94.44 (0.180) 100.00/94.44 (0.125)
Diarrhoea 100.00/100.00 (1.000) 100.00/95.83 (0.102) 100.00/97.22 (0.317) 95.83/97.22 (0.887)
9
RESULTS contd..

• Comparison of pre treatment QOL scores showed
  that the two groups are very well matched.
• SNB arm there was a statistically significant
  improvement in the mental well being and sleep of
  the patient with treatment
• There was a significant deterioration in sexual
  activity in the SNB arm .
• Bladder symptom scores for hematuria and dysuria
  showed a significant positive improvement in the
  SNB arm .
• The striking feature in the CTRT arm is an
  improvement in the family life and preservation
  of sexual activity
• Bladder symptom scores for hematuria showed a
  significant improvement in the CTRT arm too.
• A head on comparison of the post treatment status
  between two arms showed a highly statistically
  significant improvement in family life and sexual
  life in favor of CTRT

10
Conclusions

• Chemoradiation yields a slightly better Quality
  of Life than Radical Cystectomy with Sigmoid
  Neobladder in the treatment of muscle invasive
  bladder cancer.