To evaluate the degree of discomfort among patients with bladder cancer undergoing office-based cystoscopy and identify factors and interventions that influence discomfort and anxiety.
We conducted a survey of the Bladder Cancer Advocacy Network Patient Survey Network (BCAN PSN) to investigate the degree of discomfort associated with office-based cystoscopy and prevalence of interventions used to reduce discomfort. All patients had undergone at least one previous cystoscopy. Bivariable and multivariable logistic regression were used to identify factors associated with moderate-to-severe cystoscopy discomfort.
Among 488 BCAN PSN respondents (50% response rate), 392 responded with demographic data and discomfort score. Cystoscopy was associated with moderate-to-severe discomfort in 52% of patients. Respondents who reported moderate-to-severe discomfort were more likely to describe their most recent cystoscopy discomfort as worse than prior (P<0.001) and to be interested in planning discomfort mitigation for cystoscopy (P<0.001). On multivariable analysis, gender was the only factor independently associated with discomfort, with women reporting less discomfort than men (OR 0.59, 95%CI 0.37-0.95,P=0.03). Patients reported a wide variety of cystoscopy-specific interventions with differing perceived effectiveness, the most common being intraurethral lidocaine.
Over half of patients undergoing office-based cystoscopy for bladder cancer report moderate-to-severe discomfort, constituting a substantial problem among patients undergoing the procedure. Future large pragmatic comparative effectiveness trials are needed to better understand which interventions work most effectively to reduce discomfort associated with cystoscopy.
Urologic oncology. 2021 Jun 20 [Epub ahead of print]
Janet Baack Kukreja, Florian R Schroeck, Yair Lotan, John L Gore, Ralph Ullman, Robert R Lipman, Mary Beth Ballard Murray, Stephanie Chisolm, Cystoscopy Discomfort Working Group , Angela B Smith
Department of Urology, University of Colorado, Denver, CO., Section of Urology and VA Outcomes Group, White River Junction VA Medical Center, Vermont; Section of Urology, Norris Cotton Cancer Center, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH., Department of Urology, University of Texas Southwestern, Dallas, TX., Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA., Bladder Cancer Advocacy Network, Research Patient Advocate., Bladder Cancer Advocacy Network, Director of Education & Research., Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: .