Cachexia and bladder cancer: clinical impact and management

[Role of nutrition in urological prehabilitation]

Nutritional intervention plays an important role in prehabilitation, a multimodal concept designed to improve the physical condition of the patient prior to treatment in order to influence the outcome of surgery. The focus is on reducing the postoperative complication rate, while simultaneously shortening the hospital stay and the rehabilitation phase. The nutritional status should be optimized through individual counseling and the targeted intake of calories, protein, and nutritional supplements. A good nutritional status contributes to the strengthening of the immune system and improves wound healing. Especially after surgery, muscle mass declines rapidly. Adequate protein intake accompanying strength exercises can best preserve muscle and promote development of muscular fitness during prehabilitation. Despite the positive effects of nutritional interventions, prehabilitation programs with nutritional components in uro-oncology are rare and the evidence of the programs is therefore insufficient. Results from initial studies appear promising, but further prospective, randomized studies of high quality and with defined program content on the various types of cancer are needed.

Variation of Anxiety and Depression During a 3-Year Period as Well as Their Risk Factors and Prognostic Value in Postoperative Bladder Cancer Patients

Background

Anxiety and depression are commonly recognized and prognostically relevant in cancer patients. The aim of this study was to explore the 3-year longitudinal changes in anxiety and depression, their risk factors, and prognostic value in patients with bladder cancer.

Methods

Hospital Anxiety and Depression Scale for anxiety (HADS-A) and depression (HADS-D) scores of 120 postoperative bladder cancer patients and 100 healthy controls (HCs) were assessed. Additionally, the HADS-A and HADS-D scores of bladder cancer patients were determined at 1 year, 2 years, and 3 years post surgery.

Results

HADS-A score (7.7 ± 3.0 vs. 4.8 ± 2.6), anxiety rate (38.3% vs. 9.0%), HADS-D score (7.7 ± 3.3 vs. 4.3 ± 2.6), depression rate (40.0% vs. 11.0%), as well as anxiety degree and depression degree, were all increased in bladder cancer patients compared with HCs (all P < 0.001). Besides, the HADS-A score gradually increased from baseline to 3 years (P = 0.004), while the anxiety rate, HADS-D score, and depression rate did not change significantly (all P > 0.050). Gender, tumor size, marriage status, hypertension, diversity, and lymph node (LN) metastasis were associated with anxiety or depression in patients with bladder cancer (all P < 0.050). Anxiety was associated with shortened overall survival (OS) (P = 0.024) but did not link with disease-free survival (DFS) (P = 0.201); depression was not correlated with either DFS or OS (both P > 0.050).

Conclusion

The prevalence and severity of anxiety and depression are high in patients with bladder cancer, which are influenced by gender, tumor features, marriage status, and hypertension; in addition, their correlation with survival is relatively weak.