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26. Lee CT, Latini DM. Urinary diversion: evidence-based outcomesassessment and integration into patient decision-making. BJU Int.2008;102:1326-1333.

7. Ramirez A, Perrotte P, Valiquette L, et al. Exploration of health-related quality of life areas that may distinguish between continentdiversion and ileal conduit patients. Can J Urol. 2005;12:2537-2542.

8. Eortc B. Cancer QOL questionnaires. Available at: http://groups.eortc.be/qol/qolg_projects.htm. Accessed May 2011.

9. Gilbert SM, Dunn RL, Hollenbeck BK, et al. Development andvalidation of the bladder cancer index: a comprehensive, diseasespecific measure of health related quality of life in patients withlocalized bladder cancer. J Urol. 2010;183:1764-1769.

0. Hedgepeth RC, Gilbert SM, He C, et al. Body image and bladdercancer specific quality of life in patients with ileal conduit andneobladder urinary diversions. Urology. 2010;76:671-675.

APPENDIX

UPPLEMENTARY DATASupplementary data associated with this article can be found,

in the online version, at doi:10.1016/j.urology.2012.01.090.

EDITORIAL COMMENTDespite considerable interest in the morbidity and burden as-sociated with bladder cancer, few reliable measures of patient-reported outcomes, such as health-related quality of life, havebeen developed. As a result, quality of life research among menand women with bladder cancer lags behind that of otherdiseases by at least 10 years.

In this issue of Urology, Anderson and colleagues reportpsychometric properties of the FACT-VCI, a condition-specificinstrument based on the Functional Assessment of CancerTherapy (FACT) that includes 15 additional items designed toaddress concerns and deficits that often accompany cystectomy.On the basis of the reported results, the FACT-VCI is inter-nally consistent and reliable (ie, it measures the health con-structs it is designed to measure) and also appears to correlatewith external criterion, at least when compared with the more

general FACT items and subscales. The FACT-VCI’s respon-

UROLOGY 80 (1), 2012

siveness, however, could be better supported, and how well itcan differentiate between different levels of health impairment,such as disease stage, or detect disparate levels of quality of lifeaccording to urinary diversion or discriminate gender-specificissues related to cystectomy, such as sexuality, remains to beseen. These issues are not specific to the FACT-VCI but un-derscore the iterative process involved in fully assessing andvalidating health questionnaires.

Clinicians and researchers now have several tools specific forassessing quality of life among patients with bladder cancer; inaddition to the FACT-VCI, the BCI, and two European Orga-nization for Research and Treatment of Cancer (EORTC)quality of life modules—the EORTC QLQ-BLS24 and QLQ-BLM30—have been developed for use for this morbid condi-tion.1,2 Although the psychometric properties of the BCI havebeen reported previously, the EORTC instruments are in theprocess of being validated. As these tools are adopted and used,two critical questions will be answered: (1) Will quality of lifeassessment and research become widespread enough to funda-mentally change the lexicon of clinical research among bladdercancer patients (as it has in prostate cancer, for example); and(2) will we be able to apply these tools in meaningful ways toimprove how we take care of patients? Groundwork to answerthese questions has begun, but there is much work to do.

Scott Gilbert, M.D., Department of Urology, University ofFlorida, Gainesville, Florida, USA

References1. Gilbert SM, Dunn RL, Hollenbeck BK, et al. Development and

validation of the bladder cancer index: a comprehensive, diseasespecific measure of health related quality of life in patients withlocalized bladder cancer. J Urol. 2010;183(5):1764-1769.

2. European Organization for Research and Treatment of Cancer.EORTC QOL modules for bladder cancer: EORTC QLQ-BLS24,EORTC QLQ-BLM30. Available at: http://groups.eortc.be/qol/qolg_projects.htm#bladder. Accessed ***.

http://dx.doi.org/10.1016/j.urology.2012.01.091

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