PhD Thesis by Susanne Vahr Lauridsen
The large majority of risk factors during surgery are not as preventable as daily smoking and risky alcohol drinking. Smoking is the major risk factor for developing bladder cancer and about 60 % of patients undergoing radical cystectomy (RC) develop one or more postoperative complications. The risk of postoperative complications is significantly reduced after a 4-8 week preoperative smoking or alcohol cessation intervention. Evidence for perioperative smoking and alcohol cessation interventions in radical cystectomy pathways is missing.
The aims of this thesis were 1) to determine if patients undergoing robot assisted radical cystectomy developed fewer complications and had a better health related quality of life compared to patients undergoing open radical cystectomy (study I), 2) to evaluate the effect of a perioperative smoking and alcohol cessation intervention in relation to radical cystectomy on postoperative complications – the STOP-OP study (study II) and 3) to explore how patients experienced the smoking and alcohol intervention in the STOP-OP study (study II).
Material and methods
In study I we carried out a systematic literature search followed by a systematic review and metaanalysis. Study II concerned a larger RCT, the STOP-OP study currently enrolling bladder cancer patients scheduled for RC being daily smokers or drinking > 20 units of alcohol per week. Patients in study II were randomised to the Gold Standard Programme for smoking cessation and the intervention group took part in five meetings in six weeks combined with free nicotine replacement therapy; patients in the control group received standard care. Part of study II was a qualitative study in which participants from the STOP-OP study were interviewed.
In study I we included four randomised controlled trials involving a total of 239 patients. The evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days or in overall grade 3-5 complications within 30 or 90 days postoperatively, in length of stay or HRQoL. Study II analysed data from 47 patients who were daily smokers. Adherence to the intervention was very high. The continuous abstinence rate was 57 % in the intervention group and 33 % in the control group, and unadjusted analyses were not significant. Adjusting for age and sex analyses showed a five times larger odds for smoking abstinence after the intervention.
In the qualitative part of study II eleven patients from the intervention group in the STOP-OP study were interviewed. The analysis showed that the smoking and alcohol cessation intervention was experienced as an integral part of bladder cancer surgery and that returning to everyday life was a barrier for continued smoking cessation/alcohol reduction.
The smoking and alcohol cessation intervention was well received by the participants. So far no significant difference in smoking cessation has been found between the two groups. Future data collection in the STOP-OP study will focus on the effect of the combined smoking and alcohol cessation intervention on postoperative complications as well as health-related quality of life.