The natural history of symptoms, over time, in patients with bladder cancer undergoing radical cystectomy, "Beyond the Abstract," by Carly Benner, MD, MPH

BERKELEY, CA (UroToday.com) - Bladder cancer remains a significant and common cancer in the United States, with the estimated number of new diagnoses being 54 610 in men and 17 960 in women in 2013. The disease, both non-invasive and muscle-invasive, can have a major impact on the quality of life in these patients, and the burden of disease is under-appreciated and poorly studied. Given the high recurrence rates and need for close surveillance, bladder cancer has the highest lifetime treatment cost per patient amongst all cancers. Clearly, radical cystectomy for invasive bladder cancer has a significant impact on sexual and urinary function, as well as causing issues regarding body image. In addition, the operation is associated with significant peri-operative morbidity and mortality. Therefore, we sought to evaluate the natural history of symptoms, over time, in a cohort of patients undergoing radical cystectomy.

In the 33 patients studied, nearly all of who were men, we found that pain increased over time after cystectomy and remained elevated even 6 months after surgery. In addition, other symptoms, such as fatigue, spiritual well-being, and health-related quality of life, did not significantly improve after surgery. However, caregivers for these patients did not report significant feelings of burden after surgery despite lifestyle adjustments and the demands of post-operative care.

Our study characterizes the experience and symptoms of patients after cystectomy for muscle-invasive bladder cancer, and highlights the fact that many have pain for a prolonged period after surgery. Despite improved recognition of these issues in modern medical care, we may need to further focus on symptom management in patients undergoing cystectomy for cancer. We have previously shown the importance of a symptom management service in the care of patients with all stages of cancer, and believe this approach is critical to improving the overall care of cancer patients. This is in line with the current focus and efforts to ensure “patient-centered care,” and is reflected in organizational recommendations. The National Comprehensive Cancer Network provides several guidelines for supportive care of cancer patients, and the American Cancer Society Commission on Cancer now includes the requirement for availability of palliative care services for program accreditation (standard 2.4). Additional research is necessary to determine the evolution of symptoms beyond the 6-month post-operative period, as well as the best methods of managing them.

Written by:
Carly Benner, MD, MPH as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA USA

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

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