Mental Health Status Prior to Bladder Cancer Surgery Can Indicate Risk of Complications

Patient self-assessment is valuable, say investigators in The Journal of Urology®


New York, December 17, 2015

A patient’s mental health prior to surgery can influence postoperative outcomes. Removal of the bladder, or radical cystectomy (RC), is an effective treatment for locally advanced bladder cancer, but complications occur in as many as 66% of patients. In a study in The Journal of Urology®, researchers found that patients whose self-assessment of mental health was low suffered more high grade complications in the 30 days following surgery than patients with higher self-assessments.

“Prior studies have suggested that poor baseline mental health can lead to more significant postoperative complications possibly due to impaired immune response associated with higher levels of stress,” explained Scott M. Gilbert, MD, MS, of the H. Lee Moffitt Cancer Center, Tampa, FL. “This may delay both wound healing and the ability to fight infection in the postoperative state, for example. Although self-appraisal of overall well-being may mediate physiologic responses to surgery, patient-reported health status has not been extensively studied among bladder cancer patients to date, and its utility in predicting postoperative outcomes, such as complications, has not been previously examined.”

Using a quality of life survey, the Medical Outcomes Study Short Form (SF-12), patients appraised their own health and quantified the effects of disease and treatment on their overall well-being. The SF-12 is a standardized, validated questionnaire that measures composite scores for physical (PCS) and mental (MCS) components of health.

This study showed a relevant association between patient reported mental health status and high grade complications after RC for patients with bladder cancer. In 274 patients who had undergone RC and had completed the SF-12, MCS was statistically significantly lower in those who had a high grade 30-day complication rate (44.8 vs 49.8, p=0.004) but PCS was not (39.2 vs 43.8, p=0.06).

“Recognition of poor preoperative mental health may represent a potential signal warranting more proactive recognition and assessment preoperatively,” noted Dr. Gilbert.

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Notes for editors
“Preoperative Patient-Reported Mental Health is Associated with High-Grade Complications after Radical Cystectomy,” by Pranav Sharma, Carl H. Henriksen, Kamran Zargar-Shoshtari, Ren Xin, Michael A. Poch, Julio M. Pow-Sang, Wade J. Sexton, Philippe E. Spiess, and Scott M. Gilbert, DOI:  http://dx.doi.org/10.1016/j.juro.2015.07.095, The Journal of Urology®, Volume 195, Issue 1 (January 2016), published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Linda Gruner at +1 212 633 3923 or jumedia@elsevier.com to obtain copies. Journalists wishing to interview the authors should contact Scott M. Gilbert at scott.gilbert@moffitt.org.

About The Journal of Urology®Established in 1917, The Journal of Urology® (www.jurology.com) is the official journal of the American Urological Association (www.auanet.org). It is the most widely read and highly cited journal in the field. It brings to its readership all the clinically relevant information needed to stay at the forefront of this dynamic field. This top-ranking journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide and practice-oriented reports on interesting clinical observations.

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