Health-related quality of life following robotic surgery: a pilot study.

OBJECTIVES: To determine the relationship between BMI, age, and the physical, functional, and psychosocial areas of health-related quality of life (HRQoL) and patient satisfaction in women with endometrial cancer undergoing robotic-assisted surgery. METHODS: During the first two years of the robotic surgery program, we prospectively collected data concerning patient demographics and surgical outcomes. At the first postoperative visit (21 to 28 days after surgery), all participants completed a HRQoL questionnaire. We examined the association between BMI and age, as well as the different areas of HRQoL, using chi-square and ANOVA. RESULTS: Of 109 participants, 41 were 70 years of age or older, and 51 had a BMI of 30 kg/m(2) or more. Following surgery, the mean (±SD) duration of hospital stay was 1.9 ± 1.5 days, and reported pain level was highest on the second postoperative day, with a mean score of 3.4 ± 2.1 on a seven-point scale. Moreover, two thirds of women reported no pain by the first postoperative visit, and only 18.2% of women aged 70 years or older used any narcotic for pain control. These results indicated that there was little influence of the surgery on HRQoL, and women resumed typical activities within an average of 11 days after surgery. Lastly, participants' average rating of satisfaction was 6.7 on a seven-point scale. CONCLUSION: This pilot study has demonstrated the advantages for HRQoL of robotic-assisted surgery in the management of endometrial cancer. Women with endometrial cancer benefited from use of robotic surgery regardless of age or BMI.

Objectifs : Déterminer, chez les femmes présentant un cancer de l'endomètre qui subissent une chirurgie assistée par robot, la relation entre l'âge, l'IMC et les aspects physiques, fonctionnels et psychosociaux de la qualité de vie liée à la santé (QdVLS), y compris la satisfaction de la patiente. Méthodes : Au cours des deux premières années du programme de chirurgie robotisée, nous avons recueilli des données de façon prospective au sujet des caractéristiques démographiques des patientes et de leurs issues chirurgicales. Dans le cadre de la première consultation postopératoire (de 21 à 28 jours à la suite de la chirurgie), toutes les participantes ont rempli un questionnaire sur la QdVLS. Nous avons examiné l'association entre l'IMC, l'âge et les différents aspects de la QdVLS au moyen du test de chi carré et d'une analyse de variance. Résultats : Chez 109 participantes, 41 étaient âgées de 70 ans ou plus et 51 présentaient un IMC de 30 kg/m2 ou plus. À la suite de la chirurgie, la durée moyenne (±σ) de l'hospitalisation était de 1,9 ±1,5 jour; de plus, le degré de douleur signalé atteignait son apogée au deuxième jour suivant l'opération (score moyen de 3,4 ± 2,1 sur une échelle de sept points). De surcroît, les deux tiers des femmes n'ont signalé aucune douleur au cours de la première consultation postopératoire et seulement 18,2 % des femmes âgées de 70 ans ou plus ont eu recours à des narcotiques (quels qu'ils soient) aux fins de la maîtrise de la douleur. Ces résultats ont indiqué que la chirurgie n'avait exercé que peu d'influence sur la QdVLS; les femmes reprenaient leurs activités habituelles dans un délai moyen de 11 jours à la suite de la chirurgie. Enfin, le score moyen accordé par les participantes en matière de satisfaction a été de 6,7 sur une échelle de sept points. Conclusion : Cette étude pilote a démontré les avantages, en matière de QdVLS, du recours à la chirurgie assistée par robot dans le cadre de la prise en charge du cancer de l'endomètre. Les femmes présentant un cancer de l'endomètre ont tiré avantage du recours à la chirurgie robotisée, peu importe leur âge ou leur IMC.

Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer.

OBJECTIVE: This is a prospective evaluation of the outcome of minimal invasive surgery using robotics in function of the body mass index (BMI) of patients. METHODS: This is a prospective cohort study of consecutive women undergoing surgery for endometrial cancer at a tertiary care facility since the initiation of a robotic program in December 2007. Surgical and personal outcome variables as well as quality of life and postoperative recovery were assessed using a combination of objective and subjective/self-report questionnaires. Women were divided into 3 groups based on their BMI. Comparative analyses among nonobese (n = 52), obese (n = 33) and morbidly obese (n = 23) women were performed on the outcome measures after surgery. RESULTS: The mean BMI and the range in each of the BMI categories was 25 kg/m² (18.7-29.4 kg/m²), 34 kg/m² (30.1-38.4 kg/m²), and 46 kg/m² (40.0-58.8 kg/m²). Women with higher BMI tended to be more frequently affected with comorbidities such as diabetes (15.4%, 26.0%, and 27.3%, respectively; P = 0.32) and hypertension (55.8%, 69.6%, and 69.7%, respectively; P = 0.19). Despite these differences, surgical console time (P = 0.20), major postoperative complications (P = 0.52), overall wound complications (P = 0.18), and median length of hospitalization in days (P = 0.17) were not statistically different among the 3 groups. Only 5.6% of women needed a mini laparotomy all of which were performed for the removal of their enlarged uterus, which could not be delivered safely via the vagina, at the end of the surgical procedure. There was no increased conversion to laparotomy due to increased BMI. Women in all 3 groups reported rapid resumption of hygiene regimens and chores, little need for narcotic analgesia, and high satisfaction with the procedure. CONCLUSIONS: Obese and morbidly obese patients with endometrial cancer are also good candidates for robotic surgery. These women benefit considerably from minimal invasive surgery and have little perioperative complications.

Outcome and quality of life in a prospective cohort of the first 100 robotic surgeries for endometrial cancer, with focus on elderly patients.

OBJECTIVE: Evaluation of surgical outcomes, including quality of life, in patients with endometrial cancer in the early phase of implementation of a robotic surgery program, comparing elderly with younger patients. METHODS: Prospective evaluation of perioperative data and a postoperative quality-of-life survey of the first 100 robotic surgeries for endometrial cancer performed in the Division of Gynecologic Oncology at a tertiary cancer center. Women were divided in 2 groups based on age, allowing comparison of outcomes between the elderly (≥70 years) and younger groups (<70 years). RESULTS: Of the first 100 patients, 41 were elderly (mean age, 78 years). The elderly group had significantly higher number of comorbidities and more advanced disease when compared with the younger women. Despite this, elderly women had similar mean operative times (252 vs 243 minutes), mean console times (171 vs 175 minutes), and mean blood loss (83 vs 81 mL) as compared with the younger group. Conversion rate to minilaparotomy was 6%, all of which were performed at the end of surgery for the removal of enlarged uteri that could not be delivered vaginally. The overall perioperative complication rates were not statistically different between the age groups. Median hospital stay tended to be longer for the elderly women (2 vs 1 day) but was not statistically significant. The postoperative quality-of-life assessment revealed that patients young and old alike were highly satisfied with the procedure. CONCLUSIONS: Prospective evaluation indicates that even in the early phases of implementation of a robotic surgical program for endometrial cancer, the procedure seems safe and confers an excellent quality of life for elderly patients.

A quality end of life from a palliative care patient's perspective.

This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients--five women and five men--took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients' approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to "do the things that I usually do," "be helpful to others," and "live in a caring environment," The findings highlight the importance of understanding each of these factors: patients' approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.

Patients' satisfaction and importance ratings of quality in an outpatient oncology center.

Oncology patients requiring outpatient services have expectations that must be addressed to ensure continuous and improved quality of care. A convenience sample of 96 patients recruited from an oncology outpatient center completed a 26-item patient satisfaction questionnaire (SEQUS). Overall satisfaction ratings indicate that patients are satisfied with their care. Patients' perception of waiting time and lack of questioning regarding their medications by the pharmacist were identified as two areas needing improvement. Findings suggest that by identifying what is most important to patients, nurses can readily modify the care environment to enhance patient satisfaction and quality of care.