San Francisco, California ( Dr. Mark Ehlers reviewed how bladder cancer is a common cancer leading to >1,000,000 cystoscopies in the US yearly. Anxiety and discomfort have a significant impact on diagnosis and treatment. Their objective was to evaluate the degree of anxiety and discomfort associated with bladder cancer patients’ most recent cystoscopy and alleviating and exacerbating measures.  

A national survey sent to members of the Bladder Cancer Advocacy Network Patient Survey Network was developed with bladder cancer patients to analyze the association between current cystoscopy practices and discomfort and anxiety. Respondents completed a validated treatment discomfort scale. Among 382 respondents, the average age was 67 and 63% were male. 21% had 1-3 previous cystoscopies and 11% had 4-6. Cystoscopy was associated with major discomfort in 30% and anxiety in 41%. 18% had major discomfort and anxiety. 36% of patients reported less pain on their most recent cystoscopy compared with 7% reporting worse (p<0.001). Females reported 6 points lower on the treatment discomfort scale (0-100) compared with males (p=0.05). Flexible cystoscopy was associated with lower treatment discomfort scores than rigid(p=0.006). Intraurethral lidocaine was also associated with lower treatment discomfort (p=0.014). Patients who reported major discomfort associated the following measures as most effective: urojet (71%), procedure narration (52%) and damp towel (48%).

In summary, they report high levels of anxiety and discomfort associated with cystoscopy among bladder cancer patients. Factors associated with reduced discomfort included female gender, flexible cystoscopy, and intraurethral lidocaine. Measures to improve anxiety and discomfort should be promoted in urology practices to improve the patient experience.

Presented by: Mark Ehlers, MD, University of North Carolina, Chapel Hill, North Carolina

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons Clinical Congress October 27-31, 2019  – San Francisco, CA