Patients' perceived burden of cystoscopic and urinary surveillance of bladder cancer: a randomized comparison.
OBJECTIVE
To compare, in patients with non-muscle-invasive low-grade (pTa/pT1, G1/G2) urothelial cell carcinoma of the urinary bladder, the perceived burden of flexible cystoscopy or surveillance by microsatellite analysis (MA) in voided urine, as such patients are normally recommended to adhere to regular cysto-urethroscopic surveillance (CUS).


METHODS
In all, 220 participants of a randomized trial comparing CUS and surveillance by MA were asked to complete questionnaires 1 week after cystoscopy or urine sample collection. We assessed the discomfort and pain reported during CUS, experiences with MA, and physical symptoms, medical consumption and general functioning in the week after CUS/urine sampling.


RESULTS
We analysed data from 732 questionnaires (197 patients) completed after CUS and 184 (67 patients) after collecting urine. The introduction of the cystoscope was reported to cause discomfort in 39% and pain in 35% of the responses to the questionnaires; the waiting time for the results of MA was reported as burdensome in 19%. Painful micturition was significantly more frequent in the week after CUS than after MA (30% and 12%, respectively). The frequency of fever (1% and 2%) and haematuria (7% and 6%) was similar in both groups. Older patients reported significantly less pain and discomfort from cystoscopy, and this was not related to having more previous cystoscopies.


CONCLUSIONS
CUS caused pain and discomfort in about a third of patients. The burden of MA appeared fully attributable to the waiting time for the test result. The present results are a further motivation in the search for less invasive surveillance tests.
van der Aa
Madelon N M
MN
Department of Pathology, Erasmus MC/University Medical Center, Rotterdam, The Netherlands.
Steyerberg
Ewout W
EW
Sen
E Fatma
EF
Zwarthoff
Ellen C
EC
Kirkels
Wim J
WJ
van der Kwast
Theo H
TH
Essink-Bot
Marie-Louise
ML
D000223:Adaptation, Psychological; D000368:Aged; D001294:Attitude to Health; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000523:psychology*; D003558:Cystoscopy / Q000009:adverse effects / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D018895:Microsatellite Repeats; D010146:Pain / Q000209:etiology / Q000523:psychology*; D017060:Patient Satisfaction; D010465:Perception; D011788:Quality of Life; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000523:psychology*