To assess age-based differences in psychological and physical symptoms of bladder cancer (BC) patients at different disease stages.
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 (ESAS-r) questionnaire. The questionnaire was filled at three predefined time points: a) following diagnosis, b) after radical cystectomy (RC) and c) at last follow-up. The ESAS-r consists of the physical distress sub-score (PHSDSS), entailing scores of six physical symptoms, and the psychological distress sub-score (PDSS), entailing scores of three psychological symptoms. Patients were stratified to those younger and older than 65 years. Multivariable linear regression models assessed predictors of increased PDSS and PHSDSS.
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=0.004), and a higher rate of muscle-invasive disease (71.7% vs. 52.1%, p=0.008) 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.
Younger BC patients may benefit from access to psychological support services as part of a comprehensive treatment regimen, especially after diagnosis and RC.
Urology. 2019 Sep 02 [Epub ahead of print]
Rami Ajaj, Alejandro Berlin, Zachary Klaassen, Thenappan Chandrasekar, Christopher J D Wallis, Ardalan E Ahmad, Jaime Omar Herrera Cáceres, Ricardo Leao, Anika R Petrella, Neil Fleshner, Andrew Matthew, Girish S Kulkarni, Hanan Goldberg
Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada., Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto; and Techna Institute, University Health Network, Toronto, Ontario, Canada., Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA; Georgia Cancer Center, Augusta, GA, USA., Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA., Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario Canada., Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: .