Being diagnosed with cancer leads to profound effects on the patient’s mental psyche. Older cancer patients are commonly more physically compromised than their younger counterparts. One would intuitively assume that the older “frailer” cancer patient would probably experience more psychosocial problems and have a more difficult time mentally coping with his/her disease and resulting treatment. However, there is evidence dating back to almost 25 years ago showing that older cancer patients actually experience fewer negative psychosocial consequences than their younger counterparts.1
This study used the Edmonton Symptom Assessment System-revised (ESAS-r) tool, a well-known and established questionnaire developed to screen for commonly reported symptoms in cancer patients.2 This tool, which includes a psychological and physical distress sub-score, was used to evaluate 232 bladder cancer patients over 65 years and under 65 years at diagnosis, after radical cystectomy and at last follow up. Completion of the questionnaire was done voluntarily, and at each time point, the percentage of patients who qualified for and completed the survey varied. Although no difference in the physical distress sub-scores was noted between young and old patients, younger patients did demonstrate significantly higher psychological distress sub-scores at diagnosis and after radical cystectomy. The multivariable model supported our initial results and showed that increased psychological distress sub-score was more likely in younger patients after radical cystectomy.
This reported psychological distress gap between younger and older patients is not novel as it has been shown in other malignancies, including breast, endometrial, and bladder cancer. In these reports younger patients harbored worse physical and psychological distress.3-5 Specifically, in bladder cancer there are additional ramifications which could potentially worsen psychological distress, including its chronic nature, commonly resulting in numerous additional surgeries, need for lifelong follow-up, the possible loss of sexual function, altered body image, and living with an ostomy bag. Younger patients may be more psychologically affected by these adverse effects, such as the loss of sexual function, which has been shown to bother younger patients considerably more than older patients.6
This study brings to light the concerns with bladder cancer in that younger patients might suffer more psychologically from the diagnosis and treatment of bladder cancer. There could be several potential reasons for this finding, including the fact that younger patients have different demands of social roles than older patients and a different manner in which they cope with a major stressor such as cancer.7 Older patients have accumulated more life experience and may have fewer demands in life. Moreover, their partners may be more equipped to support them as they are usually not engaged in full-time employment or in raising children. Additionally, older patients have usually reached their economic goals and have had more time to accumulate funds over the years, enabling them to financially cope with their disease.
Acknowledging the tremendous psychological and psychosocial impact that cancer has on patients and their families is extremely important for cancer care professionals. This enables them to provide integrated and more comprehensive care in oncology. There is evidence showing an improved survival benefit resulting from providing psychosocial support, as part of the standard care, to patients and their families.8 The main take-home message from our study should be that bladder cancer patients should be offered routine psychological support through all stages of their disease, and this is especially true in younger patients.
Written by: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, New York, USA, Twitter: @GoldbergHanan
References:
1. Mor V, Allen S, Malin M. The psychosocial impact of cancer on older versus younger patients and their families. Cancer. Oct 1 1994;74(7 Suppl):2118-2127.
2. Boonyathee S, Nagaviroj K, Anothaisintawee T. The Accuracy of the Edmonton Symptom Assessment System for the Assessment of Depression in Patients With Cancer: A Systematic Review and Meta-Analysis. Am J Hosp Palliat Care. Apr 2018;35(4):731-739
3. Kroenke CH, Rosner B, Chen WY, Kawachi I, Colditz GA, Holmes MD. Functional impact of breast cancer by age at diagnosis. J Clin Oncol. May 15 2004;22(10):1849-1856.
4. Krajewski W, Halska U, Poletajew S, et al. Influence of Transurethral Resection of Bladder Cancer on Sexual Function, Anxiety, and Depression. Adv Exp Med Biol. 2018;1116:37-50.
5. Mohamed NE, Pisipati S, Lee CT, et al. Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices. Urol Oncol. Dec 2016;34(12):531.e537-531.e514.
6. Goldberg H, Baniel J, Mano R, Rotlevy G, Kedar D, Yossepowitch O. Orthotopic neobladder vs. ileal conduit urinary diversion: A long-term quality-of-life comparison. Urol Oncol. Mar 2016;34(3):121.e121-127.
7. Mor V, Malin M, Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr. 1994(16):191-197.
8. Bultz BD, Cummings GG, Grassi L, Travado L, Hoekstra-Weebers J, Watson M. 2013 President's Plenary International Psycho-oncology Society: embracing the IPOS standards as a means of enhancing comprehensive cancer care. Psychooncology. Sep 2014;23(9):1073-1078.
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