Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcinoma.

OBJECTIVES: To analyze gender-based differences in distress symptoms in patients with non-metastatic renal cell carcinoma (RCC) at different stages of disease. METHODS: The Edmonton Symptom Assessment System-revised (ESAS-r) questionnaire includes a physical (PHSDSS) and a psychological distress sub-score (PDSS). The ESAS-r was used to measure psychological and physical distress symptoms in localized RCC patients in a major cancer referral center between 2014 and 2017 at four predefined time points: (a) diagnosis, (b) biopsy, (c) surgery, and (d) last follow-up. Results were gender stratified, and multivariable linear regression models were used to determine associations with increased sub-scores. RESULTS: Overall, 495 patients were included with 37.2% females. No significant gender differences were seen in mean age, relevant clinical parameters, and treatment. PDSS was significantly higher in females after diagnosis (8.5 vs. 5.1, p = 0.018), biopsy (8.9 vs. 4.1, p = 0.003), and surgery (6.5 vs. 4.4, p = 0.007), while being similar at the last follow-up. The multivariable model demonstrated a statistically significant association of female gender with higher PDSS after diagnosis (B = 3.755, 95% CI 0.761-6.750), biopsy (B = 6.076, 95% CI 2.701-9.451), and surgery (B = 1.974, 95% CI 0.406-3.542). PHSDSS was significantly higher in females after biopsy (10.0 vs. 5.7, p = 0.028) and surgery (8.6 vs. 6.1, p = 0.022). In the multivariable model, female gender conferred a higher PHSDSS only after surgery (B = 2.384, 95% CI 0.208-4.560). CONCLUSIONS: Gender-associated psychological distress differences exist in non-metastatic RCC patients throughout treatment, while dissipating at last follow-up. Emphasis should be placed on screening for distress symptoms and providing psychological support continuously, particularly for female patients.

Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass.

PURPOSE: To compare the psychological distress throughout several predefined disease time points in patients younger than 70 with small renal masses (SRMs) treated with either active surveillance (AS) or ablative/surgical therapy. METHODS: Using the Edmonton Symptom Assessment System - revised (ESAS-r) questionnaire, we focused on psychological distress symptoms in all consecutive patients with an SRM between 2014 and 2017. We further evaluated the psychological distress sub-score (PDSS) of ESAS-r, consisting of the sum scores of anxiety, depression, and well-being. PDSS of patients treated with AS or ablation/surgery were compared at 4 distinct time points (before and after diagnosis, after a biopsy is performed, and at last follow-up). Multivariable linear regression models were performed to assess factors associated with worse PDSS (1-point score increase). RESULTS: We examined 477 patients, of whom 217 and 260 were treated with AS and surgery/ablation, respectively. Similar ESAS-r and PDSS scores were shown at all predefined disease time points except following an SRM biopsy and at last, follow-up, where AS-treated patients with a biopsy-proven malignancy had significantly worse PDSS (11.4 vs. 6.1, P = 0.035), and (13.2 vs. 5.4, P = 0.004), respectively. At last follow-up, multivariable linear models demonstrated that a biopsy-proven malignancy (B = 2.630, 95% CI 0.024-5.236, P = 0.048) and AS strategy (B = 6.499, 95% CI 2.340-10.658, P = 0.002) were associated with worse PDSS in all patients, and in those who underwent a biopsy, respectively. CONCLUSIONS: Offering standardized psychological supportive care may be required for patients younger than 70 years on AS for SRM, especially for those with a biopsy-proven tumor.

Age Differences in Patient-reported Psychological and Physical Distress Symptoms in Bladder Cancer Patients - A Cross Sectional Study.

OBJECTIVE: To assess age-based differences in psychological and physical symptoms of bladder cancer (BC) patients at different disease stages. METHODS: This was a cross-sectional single-center retrospective study between 2014 and 2017, assessing BC patients at different time points of their disease trajectory, after completing the Edmonton Symptom Assessment System-revised questionnaire. The questionnaire was filled at 3 predefined time points: (a) following diagnosis, (b) after radical cystectomy (RC), and (c) at last follow-up. The Edmonton Symptom Assessment System-revised consists of the physical distress sub-score (PHSDSS), entailing scores of 6 physical symptoms, and the psychological distress sub-score (PDSS), entailing scores of 3 psychological symptoms. Patients were stratified to those younger and older than 65 years. Multivariable linear regression models assessed predictors of increased PDSS and PHSDSS. RESULTS: A total of 232 patients were analyzed. No significant baseline clinical differences were demonstrated between both groups, excepting a higher Charlson comorbidity score (4.85 vs 3.87, P = .004), and a higher rate of muscle-invasive disease (71.7% vs 52.1%, P = .008) in older patients. PHSDSS scores remained similar throughout all time points in both groups. In contrast, younger patients had a significantly higher PDSS score at diagnosis, and after RC. Multivariable models demonstrated that an increased PDSS score (B = 2.372, 95% CI 0.36-4.385) was more likely in younger patients at diagnosis and after RC. An increased PHSDSS (B = 5.118, 95% CI 0.462-9.774) was more likely in younger patients only after RC. CONCLUSION: Younger BC patients may benefit from access to psychological support services as part of a comprehensive treatment regimen, especially after diagnosis and RC.