Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.

Abstract

11 Background: To characterize the impact of palliative care concurrent with usual urologic care for bladder cancer patients undergoing cystectomy. Methods: Prospective, 6 month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle invasive bladder cancer with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys pre-operatively and two, four, and six months post-operatively. Results: The intervention group saw improvements in most symptom measures over the six months following cystectomy compared to the control group. Depression and anxiety decreased over the six-month period for intervention patients, but increased over this time among controls (p=0.01). Fatigue fell to a minimum for intervention group participants at four months, while it peaked at this time for control participants (0.002). Quality of life and post-traumatic growth scores followed a similar pattern, with scores peaking at four months for the intervention group while controls reported their lowest scores at this time (p=0.01 and p=0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. Conclusions: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder had better outcomes, including improved fatigue, depression, quality of life, and post-traumatic growth. While further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for bladder cancer patients may significantly reduce post-operative symptoms.

A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy

“…The PRISMA diagram for the study selection process is shown in Figure 1. We identified 9917 records through the database search, of which eight records 17–24 met the inclusion criteria. Reasons for exclusion of full texts are also reported in the PRISMA diagram.…”

“…We included five randomized controlled trials 17,18–20,22–24 of which three conducted an exercise intervention and two a psychosocial intervention. The sixth study 21 was a non-randomized study (prospective serial cohort study) conducting a psychosocial intervention. Characteristics of the included studies are shown in Table 1.…”

“…Overall, the exercise studies in this review found evidence that exercise in bladder cancer patients significantly improved physical fitness, 17,20,24 muscle strength, 19 personal activities in daily life 20 and some health-related quality-of-life domains (role functioning, 17 dyspnea, 18 constipation, 18 abdominal flatulence 18 and urinary problems 18 ). The psychosocial interventions showed significant improvements in anxiety levels, 22 fatigue, 21 depression, 21 general health-related quality of life 21 and posttraumatic growth. 21 Since this review could only include three exercise and three psychosocial studies with heterogeneity in terms of timing, duration, supervision, type of exercises and psychosocial interventions, attrition rates and outcome measurements, it is difficult to make strong recommendations for clinical practice and standardization of such programs is needed to better evaluate these kind of interventions.…”

“…The psychosocial interventions showed significant improvements in anxiety levels, 22 fatigue, 21 depression, 21 general health-related quality of life 21 and posttraumatic growth. 21 Since this review could only include three exercise and three psychosocial studies with heterogeneity in terms of timing, duration, supervision, type of exercises and psychosocial interventions, attrition rates and outcome measurements, it is difficult to make strong recommendations for clinical practice and standardization of such programs is needed to better evaluate these kind of interventions. However, based on the results of this review, we might give some suggestions and this review could serve as a basis for developing further well-designed exercise and psychosocial studies in bladder cancer.…”

“…Since clinical practice has changed significantly in the past 20 years, the results of these studies may not be applicable to the current situation. The third psychosocial study 21 ensured good quality, but the biggest concern is the design of the study. Intervention and control group were not enrolled and assessed at the same time.…”