Impact of a Perioperative Smoking and Alcohol Cessation Intervention on Health-related Quality of Life in Patients Undergoing Radical Cystectomy: A Randomised Controlled Trial

BACKGROUND AND OBJECTIVE: The impact of a smoking and alcohol cessation intervention on health-related quality of life (HRQoL) following radical cystectomy (RC) is unclear. This study aimed to evaluate the effect of a 6-wk perioperative smoking and/or alcohol cessation intervention on HRQoL. A secondary objective was to assess the difference in HRQoL between patients with more than two and those with fewer complications.

METHODS: From 2014 to 2018, 104 patients referred to RC who smoked daily or consumed at least three alcohol units per day were enrolled in a multicentre randomised clinical trial. Participants were assigned to a 6-wk intensive smoking and/or alcohol cessation programme or standard care. The smoking cessation programme had five meetings in 6 wk and was based on the principles of motivational interviewing, balanced decision-making, and the transtheoretical model of change. HRQoL was assessed at baseline, and 6 and 12 mo using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BLM30 questionnaires. Linear regression models were used to analyse the association between intervention, complications, and HRQoL.

KEY FINDINGS AND LIMITATIONS: There were differences in baseline demographic and lifestyle factors between groups. At the end of intervention, 51% of the intervention group and 27% of the control group quit successfully; after 12 mo, 21% and 36%, respectively, were quitters. No significant differences in HRQoL were found between the intervention and control groups. However, patients with more than two complications had significantly lower HRQoL on the QLQ-C30 scale, while no difference was observed on the BLM30 scale. A study limitation is the nonparticipation rate of 53%.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The cessation intervention did not impact HRQoL significantly in patients undergoing RC. However, patients with more than two complications experienced reduced HRQoL, highlighting the importance of identifying at-risk patients preoperatively.