scholarly journals Educational and Psychological Support Combined with Minimally Invasive Surgical Technique Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Undergoing Radical Cystectomy

2021 ◽  
Vol 18 (24) ◽  
pp. 13071
Author(s):  
Artur Lemiński ◽  
Krystian Kaczmarek ◽  
Aleksandra Bańcarz ◽  
Alicja Zakrzewska ◽  
Bartosz Małkiewicz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cost Effective ◽  
Well Being ◽  
Depression Score ◽  
Anxiety And Depression ◽  
Minimally Invasive Surgical ◽  
Muscle Invasive ◽  
Supportive Program ◽  
Prolonged Hospital

Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with permanent alteration of body image and disability. Combined with the aggressive malignant potential of MIBC and considerable risk of complications, it poses a serious threat to the psychological well-being of patients. Educational deficiencies causing uncertainty and confusion aggravate surgery-related anxiety and may lead to depression along with further social disability. We conceived a preoperative supportive program named “Cystocare” held by urologists, psychologists, stoma therapists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC. We included 95 consecutive patients who filled Hospital Anxiety and Depression Score questionnaires before RC and on discharge. The intervention arm (A) comprised 32 Cystocare participants. The remaining 63 patients who received standard preparation constituted the control arm (B). Whilst there were no differences in median anxiety and depression scores preoperatively, in postoperative measurement, the intervention arm showed a lower median depression score than controls: 3 vs. 8 points, p = 0.015. On multivariate analysis we confirmed lower risk of postoperative depression in Cystocare participants: OR = 0.215 (95%CI: 0.066–0.699), p = 0.011, along with lower odds of preoperative anxiety in patients undergoing laparoscopic RC: OR = 0.365 (95%CI: 0.136–0.978), p = 0.045, and higher risk of prolonged hospital stay in patients experiencing postoperative anxiety OR = 17.114 (95%CI: 1.283–228.234) p = 0.032. Preoperative educational and supportive intervention complements laparoscopic RC in the alleviation of surgery-related anxiety and depression. The support group meetings provide an attractive and cost-effective opportunity to moderate emotional response in patients undergoing RC, and as such, deserve widespread adoption.

scholarly journals Educational and Psychological Support Combined with Minimally Invasive Surgery Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Treated with Radical Cystectomy.

2021 ◽  
Author(s):  
Artur Lemiński ◽  
Krystian Kaczmarek ◽  
Marcin Słojewski
Keyword(s):  
Bladder Cancer ◽  
Minimally Invasive ◽  
Emotional Distress ◽  
Well Being ◽  
Depression Score ◽  
Anxiety And Depression ◽  
Invasive Approach ◽  
Muscle Invasive ◽  
Supportive Program ◽  
And Coping

Abstract PurposeRadical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with a permanent alteration of body image. Combined with aggressive malignant potential of MIBC and considerable risk of complications, it may pose a serious threat to psychological well-being of patients. Educational deficiencies not infrequently encountered in everyday hospital practice, may lead to confusion and further aggravate procedure-related emotional distress. We conceived a preoperative informational and supportive program named “Cystocare”, with monthly meetings held by a team of urologists, stoma therapist, psychologists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC.MethodsWe included 95 consecutive patients who agreed to participate and returned Hospital Anxiety and Depression Score (HADS) questionnaires before RC and on discharge. The intervention arm (A) comprised 32 patients who participated in meetings, the remaining 63 constituted controls (B). Patients from arm A were significantly younger than controls (mean age arm A: 64.7 SD 8.25; arm B: 68.8 SD 7.87), there were no further differences between study arms.ResultsWe found no differences between groups in median anxiety and depression scores preoperatively. In postoperative measurement, the intervention arm showed significantly lower median depression score than controls: 3 vs 8 points, p=0.015, while the anxiety score remained comparable. On multivariate analysis we found lower odds of preoperative anxiety in patients planned for laparoscopic RC OR=0.351 (95%CI: 0.139-0.884), p=0.026, lower risk of postoperative depression in patients from arm A OR=0.253 (95% CI: 0.087-0.732) p=0.011 and higher risk of postoperative anxiety in patients whose length of stay exceeded 7 days OR=9.48 (95%CI: 1,146-78,428) p=0.037. ConclusionsPreoperative educational and supportive intervention combined with minimally invasive approach to RC seem effective in alleviation of surgery-related anxiety and depression.

scholarly journals Efficient delivery of radical cystectomy after neoadjuvant chemotherapy for muscle-invasive bladder cancer

Cancer ◽  
2011 ◽  
Vol 118 (1) ◽  
pp. 44-53 ◽  
Author(s):  
Ajjai S. Alva ◽  
Christopher T. Tallman ◽  
Chang He ◽  
Maha H. Hussain ◽  
Khaled Hafez ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Efficient Delivery ◽  
Muscle Invasive

scholarly journals Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

2011 ◽  
Vol 11 ◽  
pp. 369-381 ◽  
Author(s):  
Ramy F. Youssef ◽  
Yair Lotan
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Predictive Accuracy ◽  
Staging System ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Tnm Staging ◽  
High Rate ◽  
Recurrence Rates ◽  
Muscle Invasive

Bladder cancer is a major cause of morbidity and mortality. At initial diagnosis, 75% of patients present with non–muscle-invasive disease and 25% of patients have muscle-invasive or metastatic disease.Patients with noninvasive disease suffer from a high rate of recurrence and 10–30% will have disease progression. Patients with muscle-invasive disease are primarily treated with radical cystectomy, but frequently succumb to their disease despite improvements in surgical technique. In non–muscle-invasive disease, multiplicity, tumor size, and prior recurrence rates are the most important predictors for recurrence, while tumor grade, stage, and carcinomain situare the most important predictors for progression. The most common tool that clinicians use to predict outcomes after radical cystectomy is still the tumor-node-metastasis (TNM) staging system, with lymph node involvement representing the most important prognostic factor. However, the predictive accuracy of staging and grading systems are limited, and nomograms incorporating clinical and pathologic factors can improve prediction of bladder cancer outcomes. One limitation of current staging is the fact that tumors of a similar stage and grade can have significantly different biology. The integration of molecular markers, especially in a panel approach, has the potential to further improve the accuracy of predictive models and may also identify targets for therapeutic intervention or patients who will respond to systemic therapies.

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