Preoperative somatic symptoms are associated with disease progression in patients with bladder carcinoma after cystectomy

Authors

  • Ganesh S. Palapattu M.D.,

    1. The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, Maryland
    2. Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    3. Bladder Cancer Research Program, Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Patrick J. Bastian M.D.,

    1. The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, Maryland
    2. Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    3. Bladder Cancer Research Program, Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Phillip R. Slavney M.D.,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Mary Ellen Haisfield-Wolfe R.N.,

    1. Bladder Cancer Research Program, Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    2. Department of Surgical Nursing, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Joanne M. Walker R.N., M.S.,

    1. Department of Surgical Nursing, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Karlynn BrintzenhofeSzoc D.S.W.,

    1. Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Bruce Trock Ph.D.,

    1. The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, Maryland
    2. Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • James Zabora Sc.D.,

    1. Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Mark P. Schoenberg M.D.

    Corresponding author
    1. The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, Maryland
    2. Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    3. Bladder Cancer Research Program, Department of Urology, The Johns Hopkins University, Baltimore, Maryland
    • The James Buchanan Brady Urological Institute, 600 N. Wolfe Street, Marburg 150, Baltimore, MD 21287-2101
    Search for more papers by this author
    • Fax: (410) 955-0833


Abstract

BACKGROUND

A link between patient psychologic factors and bladder carcinoma outcome has not been demonstrated. The purpose of the current study was to assess the association of psychologic factors measured preoperatively with bladder carcinoma progression after cystectomy.

METHODS

The Brief Symptom Inventory (BSI)-18 was administered prospectively to 65 patients with clinically localized bladder carcinoma before surgery. The BSI-18 measures distress in three specific domains—depression, anxiety, and somatization (i.e., distress due to somatic symptoms)—as well as general distress. Preoperative BSI-18 scores, tumor pathologic stage, and certain clinical variables were compared with disease status. Disease progression was defined as the development of either local disease recurrence or distant metastasis. Univariate and multivariate Cox proportional hazards models were constructed for statistical analysis.

RESULTS

Of the 65 patients, 49 (79.4%) had no evidence of disease, 4 (6.2%) had local disease recurrence, and 12 (18.5%) had metastatic disease at last follow-up. The mean follow-up time was 1.3 years and did not differ significantly between survival outcomes (P = 0.577). Both tumor pathologic stage and preoperative somatic distress scores were associated with time to disease progression by univariate analysis (P = 0.038 and P = 0.055, respectively). After adjusting for tumor pathologic stage, a somatic distress score of ≥ 2.00 was a significant predictor of disease progression (P = 0.044, hazard ratio = 3.31, 95% confidence interval = 1.03–10.60). Patient age, gender, reconstruction type, and BSI-18 scores for depression, anxiety, and general distress were not significantly associated with disease outcome.

CONCLUSIONS

The authors found no correlation between psychologic symptoms measured preoperatively (i.e., depression, anxiety, and general distress) and bladder carcinoma progression. However, they reported an association between somatic symptoms and cancer outcome. If confirmed by other studies, these results may have important implications for the diagnosis, staging, and potential treatment of patients with bladder carcinoma. Cancer 2004. © 2004 American Cancer Society.

Ancillary