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

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 (alpha = 0.85), had strong retest reliability (rho = 0.891), and was associated with all FACT-G scales and total score (rho >= 0.38, P <.001). Preoperatively, the VCI-15 was internally consistent (alpha = 0.77) and was associated with the FACT-G physical and functional scales and total score (rho > 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. UROLOGY 80: 77-83, 2012. (c) 2012 Elsevier Inc.