Patient-assessed Outcomes in Swedish and Egyptian Men Undergoing Radical Cystectomy and Orthotopic Bladder Substitution--a Prospective Comparative Study

Objectives: To compare two patient populations with assumed cultural differences undergoing radical cystectomy and orthotopic bladder substitution to determine whether these translate into differences in the answers to self-report instruments.

Methods: The questionnaires Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-BL), consisting of a general version (FACT-G) and a bladder cancer specific module, and Hospital Anxiety and Depression Scale (HADS) were used preoperatively and 3 and 12 months postoperatively to assess patient well-being, urologic symptoms, depression, and anxiety in 29 and 32 Swedish and Egyptian male patients, respectively.

Results: Significant differences were found between the two groups. Higher FACT-G scores (ie, better outcomes) were obtained in the Swedish patients, both preoperatively and 3 months postoperatively, but not after 12 months. Differences were also seen in the urogenital assessment provided by the FACT-BL module. HADS revealed more depression among the Egyptian patients throughout the study period. Also, anxiety was more common preoperatively and 3 months postoperatively in the Egyptian patients, but not after 12 months.

Conclusions: Swedish men scored better than Egyptian men on the FACT-BL and HADS, although the latter improved with time after surgery. These results show that patient-assessed outcomes differ in patients from different sociocultural backgrounds. This should be recognized when analyzing results from comparative studies. Also, the use of culture-fair instruments is important when assessing patients with different sociocultural backgrounds.