Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 11-11
Author(s):  
Michael W. Rabow ◽  
Carly Benner ◽  
Nancy Shepard ◽  
Maxwell V. Meng
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Bladder Cancer ◽  
Cancer Patients ◽  
Intervention Group ◽  
Muscle Invasive Bladder Cancer ◽  
Post Traumatic Growth ◽  
Post Traumatic ◽  
Muscle Invasive

11 Background: To characterize the impact of palliative care concurrent with usual urologic care for bladder cancer patients undergoing cystectomy. Methods: Prospective, 6 month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle invasive bladder cancer with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys pre-operatively and two, four, and six months post-operatively. Results: The intervention group saw improvements in most symptom measures over the six months following cystectomy compared to the control group. Depression and anxiety decreased over the six-month period for intervention patients, but increased over this time among controls (p=0.01). Fatigue fell to a minimum for intervention group participants at four months, while it peaked at this time for control participants (0.002). Quality of life and post-traumatic growth scores followed a similar pattern, with scores peaking at four months for the intervention group while controls reported their lowest scores at this time (p=0.01 and p=0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. Conclusions: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder had better outcomes, including improved fatigue, depression, quality of life, and post-traumatic growth. While further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for bladder cancer patients may significantly reduce post-operative symptoms.

Uncertainty, post-traumatic stress, and quality of life in non-muscle-invasive bladder cancer survivors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16027-e16027 ◽  
Author(s):  
Ahrang Jung ◽  
Matthew Edward Nielsen ◽  
Sophia Kustas Smith ◽  
Jamie Crandell ◽  
Mary Happel Palmer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bladder Cancer ◽  
Traumatic Stress ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Muscle Invasive Bladder Cancer ◽  
Post Traumatic ◽  
The Mean ◽  
Muscle Invasive

e16027 Background: More than 74,000 people are diagnosed with bladder cancer every year in the US, and approximately 75% of them have non-muscle-invasive bladder cancer (NMIBC). Having a NMIBC with high recurrence rates and frequent surveillance cystoscopies followed by repeated treatment can be a source of uncertainty and post-traumatic stress disorder (PTSD) symptoms affecting survivor’s quality of life (QOL). This study was to explore the impact of cancer, cancer treatment, and surveillance procedures on uncertainty, PTSD symptoms, and QOL in patients with NMIBC. Methods: NMIBC patients, diagnosed between 2010 – 2014, were eligible for this study. Of the 5979 NMIBC population identified through North Carolina Central Cancer Registry and met the criteria, 2000 patients were randomly selected. Data were collected by postal mail survey from October to December, 2016. The Mishel Uncertainty in Illness Scale-Survivor (MUIS-S), the PTSD Checklist for DSM-5 (PCL-5), the EORTC QLQ-C30, and QLQ-NMIBC24 were used to measure uncertainty, post-traumatic stress, and QOL, respectively. Descriptive statistics, partial correlations, ANOVA, and t-test were performed. Results: 396 NMIBC survivors returned their surveys (response rate 22%). Subjects averaged 3.5 years post-diagnosis and 72.8 years of age; the majority were male (71.7%) and white (94.4%). The mean score for uncertainty was 53.3±12.0, which means moderate uncertainty. Subjects who scored at or above 33 for PCL-5 were 4.3%, which indicates having PTSD. The mean scores for QOL dimensions (global health status, function, and symptom) were 73.3±21.9, 84.6±18.5, 15.5±17.1, respectively (possible range 0-100, higher score of global health and function = better, higher score of symptom = worse). There were significant correlations between uncertainty, PTSD symptoms, and all QOL dimensions (all p < 0.001). Conclusions: Higher levels of uncertainty and PTSD symptoms were inversely related with QOL. Thus, future work should continue to explore the antecedents of uncertainty and PTSD symptoms and to identify the relationships among antecedents, uncertainty, PTSD symptoms, and QOL for intervention studies in high risk NMIBC survivors.

A phase II trial of risk-adapted treatment for muscle invasive bladder cancer after neoadjuvant accelerated MVAC.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. TPS537-TPS537 ◽  
Author(s):  
Daniel M. Geynisman ◽  
Philip Abbosh ◽  
Matthew R. Zibelman ◽  
Rebecca Feldman ◽  
David James McConkey ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Bladder Cancer ◽  
Active Surveillance ◽  
Phase Ii ◽  
Standard Of Care ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

TPS537 Background: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy (Cx) or chemoradiation (CRT) is the standard of care for urothelial carcinoma (UC) pts with muscle invasive bladder cancer (MIBC). Both Cx and CRT carry potential short and long-term toxicity and quality of life implications. Recent work has shown that mutations in DNA damage repair/response genes are predictive of pathologic downstaging after NAC at the time of Cx, with those pts achieving pT0 disease demonstrating excellent long-term survival (Van Allen et al. Cancer Discov. 2014; Plimack et al. Eur Urol. 2015; Liu et al. JAMA Oncol. 2016; Teo et al. CCR. 2017). Sparing pts Cx or CRT after NAC without compromising oncologic outcomes would improve quality of life and decrease morbidity. Methods: A phase II, parallel arm, multi-institutional clinical trial (NCT02710734) is being conducted to evaluate a risk-adapted approach to treatment of MIBC. Pts with cT2-T3N0M0 UC of the bladder, ECOG PS 0-1 and CrCl≥50 mL/min, undergo NAC with accelerated methotrexate, vinblastine, doxorubicin, and cisplatin. Simultaneously, the pre-NAC TURBT specimen is submitted for deep sequencing to identify variants in a panel of cancer-relevant genes (Caris Life Sciences, Phoenix, AZ). Those with an alteration in ATM, RB1, FANCC or ERCC2 and no clinical evidence of disease by restaging TUR and imaging post-NAC will begin a pre-defined active surveillance regimen that includes urinary cytological, cystoscopic, and radiographic evaluations. The remaining pts will undergo bladder-directed therapy at the discretion of the pt and clinician applying either intravesical therapy ( < cT2 post-NAC), CRT or Cx (≤cT2 post-NAC) or Cx (≥cT3 post-NAC). The primary objective is metastasis-free survival (MFS) at 2 years for all enrolled and evaluable pts. The trial has a non-inferiority design with a 14% margin between risk-adapted treatment (MFS = 78%) and standard-of-care (MFS = 64%) with a sample size of 70 pts, 82% power and a type I error of 0.045. Key secondary and translational objectives: assess the rate of UC recurrence in active surveillance pts; validate biomarkers of response to NAC; evaluate urinary biomarkers consistent with persistent UC. Clinical trial information: NCT02710734.

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