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J Urol. 2014 Apr;191(4):937-42. doi: 10.1016/j.juro.2013.10.101. Epub 2013 Oct 29.

The natural history of symptoms and distress in patients and families following cystectomy for treatment of muscle invasive bladder cancer.

Author information

  • 1Division of General Internal Medicine, University of California-San Francisco, San Francisco, California. Electronic address: carly.benner@ucsf.edu.
  • 2Division of General Internal Medicine, University of California-San Francisco, San Francisco, California.
  • 3Department of Nursing, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California.
  • 4Department of Urology, University of California-San Francisco, San Francisco, California.

Abstract

PURPOSE:

We characterized the natural history of symptoms with time in patients with bladder cancer undergoing cystectomy.

MATERIALS AND METHODS:

For 6 months we followed 33 participants treated with muscle invasive bladder cancer treatment with cystectomy in this prospective cohort study. Patients and family caregivers completed validated symptom assessment and satisfaction surveys at baseline, and 2, 4 and 6 months later. Primary outcomes were the change from baseline in pain, fatigue, depression, anxiety, quality of life and spiritual well-being. Secondary outcomes included posttraumatic growth, patient satisfaction and family caregiver burden.

RESULTS:

Pain increased after radical cystectomy and remained increased 6 months postoperatively based on Brief Pain Inventory scores (baseline and 6-month scores 4.0, 95% CI 0-8.0 and 9.8, 95% CI 1.9-17.6, respectively, p = 0.03). Posttraumatic growth showed a trend toward an increase at 2 months (p = 0.06). Fatigue peaked at 4 months but did not change significantly with time (p = 0.12). There was similarly no significant change with time in depression, anxiety, quality of life, spiritual well-being or satisfaction. Neither family caregiver burden nor satisfaction showed a statistically significant change with time postoperatively.

CONCLUSIONS:

Pain increased after radical cystectomy and remained increased 6 months postoperatively. There was a trend toward increased posttraumatic growth at 2 months. Otherwise, by 6 months cystectomy was associated with no improvement in preoperative symptoms of fatigue, quality of life, spiritual well-being, depression or anxiety. After cystectomy pain should be assessed and treated more aggressively in patients with bladder cancer and efforts should be made to improve postoperative symptoms.

KEYWORDS:

cystectomy; pain; quality of life; questionnaires; urinary bladder neoplasms

PMID:
24184369
DOI:
10.1016/j.juro.2013.10.101
[PubMed - indexed for MEDLINE]
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