title: Assessment of perioperative psychological distress in patients undergoing radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  Despite a recent growth in our understanding of the impact of psychosocial factors on the outcome of patients with cancer there is still relatively little known about the effect of these issues on patients with genitourinary malignancies. We determined the prevalence of psychological distress in patients with bladder cancer prior to and following radical cystectomy.
  
  
  METHODS
  A total of 74 consecutive patients with clinically organ confined bladder cancer were prospectively surveyed preoperatively using the Basic Symptom Inventory-18, a validated instrument that measures the psychological domains of general distress, anxiety, depression and somatization. Of the initial 74 patients 62 were available for postoperative assessment 1 month following cystectomy. Preoperative and postoperative distress scores were evaluated with respect to age, sex, marital status, type of surgical reconstruction and tumor stage.
  
  
  RESULTS
  The preoperative prevalence of psychological distress in patients diagnosed with bladder cancer was 45% and it remained somewhat increased at 34% approximately 4 weeks after cystectomy. Demographic factors such as gender, age, and marital status were not significantly associated with the overall prevalence of distress. In the entire study group there was a statistically significant decrease in general distress (p = 0.028), depression (p = 0.034) and anxiety (p = 0.0004) from the preoperative to the postoperative assessments. Pathological stage was significantly associated with post-cystectomy anxiety (p = 0.040) and general distress (p = 0.042).
  
  
  CONCLUSIONS
  Our findings indicate that a large proportion of patients with bladder cancer undergoing radical cystectomy experience psychological distress during the perioperative period. The identification of psychological distress in this population has the potential to influence health related quality of life as well as recovery in all individuals with bladder cancer.
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Bladder Cancer Research Program, Baltimore, Maryland 21287-2101, USA.
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Haisfield-Wolfe
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Walker
authors.forename: Karlynn
authors.initials: K
authors.lastname: BrintzenhofeSzoc
authors.forename: Bruce
authors.initials: B
authors.lastname: Trock
authors.forename: James
authors.initials: J
authors.lastname: Zabora
authors.forename: Mark
authors.initials: M
authors.lastname: Schoenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*