title: Patient-assessed outcomes in Swedish and Egyptian men undergoing radical cystectomy and orthotopic bladder substitution--a prospective comparative study.
abstract: OBJECTIVE
  To compare two patient populations with assumed cultural differences undergoing radical cystectomy and orthotopic bladder substitution to determine whether these translate into differences in the answers to self-report instruments.
  
  
  METHODS
  The questionnaires Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-BL), consisting of a general version (FACT-G) and a bladder cancer specific module, and Hospital Anxiety and Depression Scale (HADS) were used preoperatively and 3 and 12 months postoperatively to assess patient well-being, urologic symptoms, depression, and anxiety in 29 and 32 Swedish and Egyptian male patients, respectively.
  
  
  RESULTS
  Significant differences were found between the two groups. Higher FACT-G scores (ie, better outcomes) were obtained in the Swedish patients, both preoperatively and 3 months postoperatively, but not after 12 months. Differences were also seen in the urogenital assessment provided by the FACT-BL module. HADS revealed more depression among the Egyptian patients throughout the study period. Also, anxiety was more common preoperatively and 3 months postoperatively in the Egyptian patients, but not after 12 months.
  
  
  CONCLUSIONS
  Swedish men scored better than Egyptian men on the FACT-BL and HADS, although the latter improved with time after surgery. These results show that patient-assessed outcomes differ in patients from different sociocultural backgrounds. This should be recognized when analyzing results from comparative studies. Also, the use of culture-fair instruments is important when assessing patients with different sociocultural backgrounds.
authors.affiliation: Department of Health Sciences, Lund University Faculty of Medicine, Lund, Sweden. asa.mansson@med.lu.se
authors.forename: Asa
authors.initials: A
authors.lastname: Månsson
authors.forename: Maaz
authors.initials: M
authors.lastname: Al Amin
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Hans
authors.initials: H
authors.lastname: Wijkström
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol Enein
authors.forename: Wiking
authors.initials: W
authors.lastname: Månsson
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001294:Attitude to Health; D015653:Cystectomy / Q000009:adverse effects / Q000523:psychology; D003863:Depression / Q000209:etiology; D004534:Egypt; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden; D001749:Urinary Bladder Neoplasms / Q000523:psychology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000523:psychology; D014555:Urination Disorders / Q000209:etiology