title: Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.
abstract: OBJECTIVE
  To characterize the effect of palliative care provided concurrently with usual urologic care for patients with bladder cancer 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 preoperatively and at 2, 4, and 6 months postoperatively.
  
  
  RESULTS
  The intervention group saw improvements in most symptom measures over the 6 months following cystectomy compared with the control group. Depression and anxiety decreased over the 6-month period for the intervention group patients but increased over this time among the controls (P = 0.01). Fatigue decreased to a minimum for the intervention group participants at 4 months, whereas it peaked at this time for control participants (0.002). Quality-of-life and posttraumatic growth scores followed a similar pattern, with scores peaking at 4 months for the intervention group whereas 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 cancer had better outcomes, including improved fatigue, depression, quality of life, and posttraumatic growth. Although further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for patients with bladder cancer may significantly reduce postoperative symptoms.
authors: Department of Medicine, UCSF, San Francisco, CA. Electronic address: mike.rabow@ucsf.edu.
authors: Michael W
authors: MW
authors: Rabow
authors: Department of Medicine, UCSF, San Francisco, CA.
authors: Carly
authors: C
authors: Benner
authors: Department of Nursing, Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA.
authors: Nancy
authors: N
authors: Shepard
authors: Department of Urology, UCSF, San Francisco, CA.
authors: Maxwell V
authors: MV
authors: Meng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Bladder cancer; Cystectomy; Distress; Palliative care; Symptoms