Rami Ajaj1, Alejandro Berlin2, Zachary Klaassen3, Thenappan Chandrasekar4, Christopher J D Wallis1, Ardalan E Ahmad1, Jaime Omar Herrera Cáceres1, Ricardo Leao1, Anika R Petrella5, Neil Fleshner1, Andrew Matthew5, Girish S Kulkarni1, Hanan Goldberg6. 1. Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. 2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Techna Institute, University Health Network, Toronto, Ontario, Canada. 3. Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA; Georgia Cancer Center, Augusta, GA. 4. Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA. 5. Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario Canada. 6. Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: gohanan@gmail.com.
Abstract
OBJECTIVE: To assess age-based differences in psychological and physical symptoms of bladder cancer (BC) patients at different disease stages. METHODS: This was a cross-sectional single-center retrospective study between 2014 and 2017, assessing BC patients at different time points of their disease trajectory, after completing the Edmonton Symptom Assessment System-revised questionnaire. The questionnaire was filled at 3 predefined time points: (a) following diagnosis, (b) after radical cystectomy (RC), and (c) at last follow-up. The Edmonton Symptom Assessment System-revised consists of the physical distress sub-score (PHSDSS), entailing scores of 6 physical symptoms, and the psychological distress sub-score (PDSS), entailing scores of 3 psychological symptoms. Patients were stratified to those younger and older than 65 years. Multivariable linear regression models assessed predictors of increased PDSS and PHSDSS. RESULTS: A total of 232 patients were analyzed. No significant baseline clinical differences were demonstrated between both groups, excepting a higher Charlson comorbidity score (4.85 vs 3.87, P = .004), and a higher rate of muscle-invasive disease (71.7% vs 52.1%, P = .008) in older patients. PHSDSS scores remained similar throughout all time points in both groups. In contrast, younger patients had a significantly higher PDSS score at diagnosis, and after RC. Multivariable models demonstrated that an increased PDSS score (B = 2.372, 95% CI 0.36-4.385) was more likely in younger patients at diagnosis and after RC. An increased PHSDSS (B = 5.118, 95% CI 0.462-9.774) was more likely in younger patients only after RC. CONCLUSION: Younger BC patients may benefit from access to psychological support services as part of a comprehensive treatment regimen, especially after diagnosis and RC.
OBJECTIVE: To assess age-based differences in psychological and physical symptoms of bladder cancer (BC) patients at different disease stages. METHODS: This was a cross-sectional single-center retrospective study between 2014 and 2017, assessing BC patients at different time points of their disease trajectory, after completing the Edmonton Symptom Assessment System-revised questionnaire. The questionnaire was filled at 3 predefined time points: (a) following diagnosis, (b) after radical cystectomy (RC), and (c) at last follow-up. The Edmonton Symptom Assessment System-revised consists of the physical distress sub-score (PHSDSS), entailing scores of 6 physical symptoms, and the psychological distress sub-score (PDSS), entailing scores of 3 psychological symptoms. Patients were stratified to those younger and older than 65 years. Multivariable linear regression models assessed predictors of increased PDSS and PHSDSS. RESULTS: A total of 232 patients were analyzed. No significant baseline clinical differences were demonstrated between both groups, excepting a higher Charlson comorbidity score (4.85 vs 3.87, P = .004), and a higher rate of muscle-invasive disease (71.7% vs 52.1%, P = .008) in older patients. PHSDSS scores remained similar throughout all time points in both groups. In contrast, younger patients had a significantly higher PDSS score at diagnosis, and after RC. Multivariable models demonstrated that an increased PDSS score (B = 2.372, 95% CI 0.36-4.385) was more likely in younger patients at diagnosis and after RC. An increased PHSDSS (B = 5.118, 95% CI 0.462-9.774) was more likely in younger patients only after RC. CONCLUSION: Younger BC patients may benefit from access to psychological support services as part of a comprehensive treatment regimen, especially after diagnosis and RC.
Authors: Christopher J D Wallis; James W F Catto; Antonio Finelli; Adam W Glaser; John L Gore; Stacy Loeb; Todd M Morgan; Alicia K Morgans; Nicolas Mottet; Richard Neal; Tim O'Brien; Anobel Y Odisho; Thomas Powles; Ted A Skolarus; Angela B Smith; Bernadett Szabados; Zachary Klaassen; Daniel E Spratt Journal: Eur Urol Date: 2020-09-04 Impact factor: 20.096