Elsevier

Urology

Volume 80, Issue 1, July 2012, Pages 77-83
Urology

Health Outcomes Research
Psychometric Characteristics of a Condition-specific, Health-related Quality-of-life Survey: The FACT-Vanderbilt Cystectomy Index

https://doi.org/10.1016/j.urology.2012.01.090Get rights and content

Objective

Radical cystectomy (RC) for bladder cancer can be associated with significant morbidity and alterations in health-related quality of life (HRQOL). The Functional Assessment of Cancer Therapy—Vanderbilt Cystectomy Index (FACT-VCI) is a condition-specific HRQOL survey for patients undergoing RC and urinary diversion (UD) for bladder cancer. This study evaluates the reliability, validity, and responsiveness of the Vanderbilt cystectomy index (VCI).

Methods

The FACT-VCI was administered to patients with bladder cancer undergoing RC and UD (n = 190) at 2 major cancer centers. Statistical methods included principal components analysis, Cronbach's coefficient alpha, and nonparametric correlation coefficients. The Functional Assessment of Cancer Therapy—General (FACT-G) was used to test criterion-related validity and a linear mixed model tested the effects of time and diversion type on longitudinal VCI scores.

Results

A single summary score of 15 gender-neutral items (VCI-15) represented the optimum solution for postoperative data, which was internally consistent (α = 0.85), had strong retest reliability (ρ = 0.891), and was associated with all FACT-G scales and total score (ρ ≥ 0.38, P <.001). Preoperatively, the VCI-15 was internally consistent (α = 0.77) and was associated with the FACT-G physical and functional scales and total score (ρ ≥ 0.41, P <.001). Although VCI-15 scores at postoperative year 1 did not differ from preoperative values overall (P = .145), they did differ by diversion type (P = .027), with no substantive change after orthotopic neobladder (40 ± 9 vs 39 ± 10) but with a clinically significant improvement after an ileal conduit (39 ± 11 vs 44 ± 11).

Conclusion

The VCI-15 is a reliable and valid condition-specific HRQOL survey for patients with bladder cancer undergoing RC and UD. Future studies of RC patients should measure HRQOL using validated, condition-specific forms, such as the FACT-VCI.

Section snippets

The FACT-VCI

The FACT-VCI was developed using input from experts in the treatment of bladder cancer and patients who previously underwent RC and UD and is validated using postoperative data (available as supplementary material online).10 It is based on the Functional Assessment of Cancer Therapy–General (FACT-G) questionnaire, which is a validated and reliable tool that measures generic HRQOL in patients being treated for cancer.14 The FACT-VCI consists of the FACT-G along with 17 additional questions (the

Demographic and Clinical Data

One-hundred ninety patients were included in the analyses. Average age at the time of surgery was 67 ± 10 years, 61% were male, and 53% of patients underwent ONB, while 37% underwent IC. Sixty-eight percent of patients had ≥T2 disease and 86% had negative lymph nodes.

Principal Components Analyses

Exploratory principal components analysis of postoperative VCI data indicated that the items were best represented by a single component solution ([VCI-15]; Table 1), which accounted for 33% of the total item covariance (overall

Comment

A comprehensive analysis of the psychometric properties of the gender-neutral VCI items indicated that a simple 15-item summary (VCI-15) is a reliable and valid instrument for the measurement of condition-specific HRQOL before and after RC and UD in men and women with bladder cancer. The survey should be scored such that responses on items 1–15 are summed to form a total score, and VCI items 16 (“I am interested in sex”) and 17 (“I am able to have and maintain an erection”) are scored

Conclusions

Analyses of the psychometric properties of the FACT-VCI demonstrate that a simple 15-item summary score, the VCI-15, is a gender-neutral, reliable, and valid measure of condition-specific HRQOL in patients who undergo RC and UD. Future studies of bladder cancer patients should prospectively measure HRQOL using validated, condition-specific forms, such as the FACT-VCI.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

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