Quality of life and psycho-emotional wellbeing in bladder cancer patients and their caregivers: a comparative analysis between urostomy versus ileal orthotopic neobladder

Factors influencing health-related quality of life in patients with bladder or kidney cancer: a prospective cohort study of the impact of nutritional status and frailty phenotype

PURPOSE

This study aimed to investigate the impact of nutritional status and frailty phenotype and the predictors of temporal changes on health-related quality of life (HRQoL) of patients with bladder or kidney cancer.

METHODS

Frailty phenotype, Patient-Generated Subjective Global Assessment, and Quality-of-life questionnaire Core-30 were applied twice to patients diagnosed with bladder or kidney cancer. Patients also completed a sociodemographic questionnaire, and clinical data were collected from records.

RESULTS

Sixty-two individuals completed the study, mostly male, with a mean age of 62.5 (± 11.4) years. The median time of follow-up was 14.5 months. Role functioning, emotional functioning, and fatigue improved over time (p < 0.05). The factors that negatively affected the long-term quality of life summary score were being female, malnourished, pre-frail and frail, cancer treatment, performance status, and lower income. Using the multivariate model, being malnourished (β =  - 7.25; 95% CI, - 10.78 to - 3.71; p < 0.001), frail (β =  - 7.25; 95% CI, - 13.39 to - 1.11; p = 0.021), and each one-point increase in performance status (β =  - 6.9; 95% CI, - 9.54 to - 4.26; p < 0.001), were the ones that most negatively impacted the HRQoL between the two assessments.

CONCLUSION

This study confirmed that frailty, nutritional status, and performance status are the main predictors of HRQoL of patients with bladder or kidney cancer over time.

IMPLICATIONS FOR CANCER SURVIVORS

These findings may be the first step towards highlighting the importance of preventing malnutrition and frailty, in favor of a better long-term QoL for cancer patients.

"I was in a very deep, dark place... I wasn't prepared for that": A qualitative assessment of the emotional well-being needs of patients undergoing cystectomy

INTRODUCTION

Studies have shown that cystectomy has a large psychological burden on patients with bladder cancer. However, there has been little work characterizing areas of improvement. This project aimed to understand cystectomy patients' experiences and to identify patient-centered methods to improve perioperative support.

METHODS

Five focus groups, divided by diversion type and gender, (4 virtual, 1 in person) of patients with bladder cancer (n = 17) who underwent cystectomy were conducted. Conversations were transcribed and qualitatively analyzed using the Sort and Sift, Think and Shift© method. Transcripts were coded in NVivo and themes were summarized in higher-level analysis.

RESULTS

Patients described feelings of depression, anger, and anxiety in response to their cancer diagnosis, need for cystectomy, and living with urinary diversion. Patients experienced daily mental hardship while adapting. They experienced distress from diversion visibility in public and private encounters. Many expressed a dichotomy of feeling grateful for the treatment while also feeling bitter about the impact on their daily life. Patients reported that while their care team provided support for tangible needs, they did not provide information for nor discuss mental and sexual health needs during this time. Patients reported that if their provider had initiated discussions and offered referrals, they would have accepted support. Patients also emphasized the benefit of social and peer support networks for emotional support.

CONCLUSIONS

Groups identified the psychological difficulties of bladder cancer diagnosis and cystectomy. Potential avenues for improvement included incorporating support resources into the care plan and perioperative discussion regarding the emotional impact of surgery.

Supportive care needs of the family caregivers of urostomy patients: a qualitative study

Family caregivers play a vital role during the home care of urostomy patients by providing direct care and support. The role of family caregivers may extend to several years, even over ten years, in certain cases. In this process, the caregivers are impacted in various ways due to the patient's conditions and may not be able to identify and address their own needs, which often get ignored and remain unfulfilled. The present study aimed to explore the supportive care needs of such family caregivers of urostomy patients. The method of qualitative research with the aid of purposive sampling was adopted in the present study. A semi-structured interview was conducted with 22 family caregivers of urostomy patients. Each interview lasted 60 min. Data analysis was conducted by employing the NVivo software for qualitative research and using a thematic approach. Four themes were identified: (i) Strong psychological and physical needs; (ii) Eagerness for information regarding the patient's diseases; (iii) Need for social support; (iv) Necessity of spiritual support. Further, within these four themes, eight sub-themes were constructed using coders. The respondents reported that they felt equally under pressure as the urostomy patients they were caring for, although the medical staff appeared to be paying little attention to them. The medical staff paid greater attention to the patients, while the caregivers also required their help and support. The need for supportive care is quite common among the family caregivers of patients with urostomy. Medical staff should comprehensively understand the needs of the family caregivers of urostomy patients and then actively provide targeted psychological/physical/information/social/spiritual support to these caregivers. This would result in enhanced caregiving skills and reduced burden among these caregivers.

Stoma Acceptance Mediates Body Image Distress and Mental Health-Related Quality of Life: A Single-Center Study on Radical Cystectomy Patients with Ureterostomy

Background: Muscle-invasive bladder cancer and subsequent radical cystectomy with ureterocutaneostomy significantly impact patients' body image and quality of life, potentially increasing the risk of adverse mental health outcomes. Acceptance may represent a psychosocial resource to buffer the effects of body image impairment on health, thereby supporting stoma adjustment and preserving quality of life. Objective: This study aimed to investigate the mediating role of stoma acceptance in the relationship between body image distress and mental health. Methods: A single-center cross-sectional survey was conducted with 73 muscle-invasive bladder cancer patients undergoing radical cystectomy with ureterocutaneostomy. Participants completed structured, anonymous self-report measures assessing body image distress, stoma acceptance, and mental health-related quality of life through validated questionnaires. Results: Statistical analyses revealed significant negative correlations between body image distress and mental health and stoma acceptance. Conversely, stoma acceptance was significantly and positively associated with mental health. Regression-based mediation modeling indicated that stoma acceptance exerted a significant mediating effect on the relationship between body image and mental health-related quality of life. Conclusions: These findings highlight the considerable and unprecedented role of stoma acceptance as a mediating factor that may promote the adjustment and enhance the quality of life of urostomy patients. Further research is warranted to explore interventions targeting stoma acceptance to prevent body image distress and promote mental health.

Caregiver Burden in Bladder Cancer Patients with Urinary Diversion Post-Radical Cystectomy and the Need for Comprehensive Nursing Education: A Narrative Literature

Background

Bladder cancer ranks seventh in global cancer prevalence. Radical cystectomy and urinary diversion are standard for muscle-invasive bladder cancer. Family caregivers shoulder a substantial care burden, affecting their own quality of life, with repercussions extending to patients' health-related quality of life (HRQOL).

Objective

This narrative review aims to highlight the major concerns perceived by the caregivers and efficacy of nurse-led interventions in alleviating their concerns and improving HRQOL.

Methods

A systematic search of the PubMed, CINAHL, and Science Direct databases was carried out to identify studies published in the last 5 years (from Jan 2018 to Aug 2023) that have evaluated the concerns and problems of caregivers attending bladder cancer patients with urinary diversion. Additionally, studies evaluating the efficacy of nurse-led interventions in alleviating these concerns were also searched.

Results

Overall, 6 studies involving 933 BC patients with UD and 1042 caregivers were identified as suitable for inclusion in this narrative literature review. Major concerns identified included psychological well-being, medical assistance needs, and peer support. Significant psychological impact was evident in the caregivers which operated in a dyadic manner. Nurse-led stoma education programs have demonstrated potential in enhancing caregivers' quality of life, although they remain restricted.

Conclusion

Emphasizing caregivers' role and program effectiveness is critical. Our review addresses these gaps, focusing on caregivers' concerns and the impact of nursing education for improved patient outcomes.

Implications for Practice

Holistic and collaborative approach could enhance the overall well-being and quality of life of bladder cancer patients and their caregivers.

Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study

Introduction

Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels.

Methods

16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires.

Results

Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged.

Conclusion

On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.

Caregiver experiences of caring for family members with urostomy: a qualitative study

OBJECTIVE

In China, bladder tumors rank first for morbidity and mortality among urological and reproductive system tumors. Total radical cystectomy plus urinary flow conversion is the gold standard for the treatment of muscle-layer invasive bladder cancer. With an increasing number of radical cystectomies each year, the number of patients living with urostomy is growing. After discharge, primary care of urostomy patients is given at home, and high demands are placed on home caregivers due to issues of privacy and the complexity of replacing the urostomy device. This research explored the challenges faced by the family caregivers of urostomy patients.

METHODS

We used descriptive qualitative research methods to conduct interviews with twenty-five family caregivers of patients with urostomy. Survey subjects were from five general hospitals. All interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Three critical challenges were identified-confusion, family crisis, and struggle psychology. Within these three themes, six sub-themes were constructed by coders. They were knowledge and skill deficiency, strong insecurities and uncertainties, role conflict, economic burden, emotional overwhelmed and calm acceptance.

CONCLUSION

Family caregivers play a critical role in patient care, and especially in urostomy care. Caregiving is associated with significant challenges that hinder the family caregiver's ability to effectively care for the patient, further diminishing the caregiver's quality of life. Therefore, healthcare professionals should consider the challenges faced by family caregivers and take measures to obviate them through education, preparation, and support.

Development and preliminary validation of a PROS scale for Chinese bladder cancer patients with abdominal stoma

Bladder cancer is a common malignant tumor, and patients who have undergone radical cystectomy and urinary diversion require a lifelong abdominal stoma. This greatly affects their physiological, psychological, and social well-being. However, there is currently a lack of a self-assessment outcome scale specifically designed for bladder cancer patients with abdominal stomas. Therefore, we developed and validated a self-assessment outcome scale (PROS-BCAS) for Chinese bladder cancer patients with abdominal stomas. The scale was initially developed through literature research and expert consultation, and it comprised four dimensions: physiological, psychological, social, and treatment, with a total of 66 items. After item analysis, 44 items were retained. We collected scale data from 382 patients to examine its validity and reliability. The results showed that the PROS-BCAS scale had good content validity (S-CVI/Ave = 0.992), construct validity (KMO > 0.6), and discriminant validity (correlation coefficient 0.404-0.870). The Cronbach's alpha coefficients (0.801-0.954), test-retest reliability (0.778-0.956), and split-half reliability (0.896-0.977) all demonstrated good internal consistency for each dimension and the overall scale. The study demonstrated that the PROS-BCAS scale is a reliable and valid tool for accurately assessing the health-related quality of life of bladder cancer patients with abdominal stomas, providing reference for developing individualized clinical care plans.

Management of the patient with urostomy: Caregiver needs during the three months after discharge. A qualitative study

OBJECTIVE

To examine caregivers' experiences and training needs after radical cystectomy with urinary diversion for the first three months following the patient's discharge.

METHODS

This study applied a phenomenological design approach through open-ended interviews and descriptive analysis. Phenomenology applied to empirical research requires researchers to explore the empirical facts narrated by partici-pants. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines, a 32 - item checklist for inter-views and focus groups. The study population included caregivers of bladder cancer patients, admitted to three Italian hospitals. Data were collected between March 2020 and March 2022.

RESULTS

Fifty-two caregivers of patients who underwent cystecto-my with urinary diversion from three Italian hospitals (41 males and 11 females) participated to the study. The data analysis con-verged in the identification of three themes - with sub-themes -that included various aspects of the caregiver's lived experiences: 1) living with the burden of being indispensable, for the family member, 2) feeling abandoned by institutions, 3) tiredness and less willingness to look after the relative due to work burden.

CONCLUSIONS

Our study demonstrates that the caregiver of a patient with bladder cancer and urostomy in the first three months of hospital discharge is very worried and stressed. Despite the training program received in hospital, the caregiver does not recognize the newly acquired skills and has difficulty applying them. Further study would be required.

Enhanced Nursing Care for Improving the Self-Efficacy & Health-Related Quality of Life in Patients with a Urostomy

Background

Bladder cancer is the most predominant cancer of the lower urinary tract and is the most common cause for urostomy or urinary diversion. Urostomy immensely affect the patient's everyday life from minor physical activity to social relations. Nurse-led interventions have been evaluated for improvement in quality of life in patients with urostomy.

Objective

The main objective of this study was to review the medical literature in a systematic way to evaluate the nursing role in improving the health-related quality of life of patients undergoing urostomy.

Methods

A systematic search of the PubMed, CINAHL, Embase, and Science Direct databases was carried out to identify studies that have evaluated the effect of nurse-led intervention on the self-efficacy and health-related quality of life in patients with urostomy. In addition, studies for factor affecting the quality of life were also investigated.

Results

Overall, 10 studies were identified as suitable for inclusion in this review. Health-related quality of life was lower in these patients as compared to population norms and several factors such as age, employment, and living status were identified as the contributing factors. Preoperative education was critical in meeting the psychological needs while postoperative intervention was instrumental in improving the self-efficacy and health-related quality of life particularly when a continued nursing-patient interaction was existent.

Conclusion

A comprehensive nurse-led intervention consisting of preoperative and postoperative components aimed at ostomy-related education, psychological counseling and compliant with patient factors is feasible and may result in greater improvement in self-efficacy and health-related quality of life in patients with urostomy. Larger clinical trials are warranted to validate these results.

A Comprehensive Analysis of the Cancer Chronic Pain Experience: A Narrative Review

Cancer-related chronic pain (CP) represents a critical clinical issue through the disease, severely compromising the quality of life (QoL) of patients and the family environment. The current review employed a narrative method to synthesize the main results about the impact of cancer-related CP on QoL, adopting a multidimensional and threefold vision: patients, caregivers, and patient–caregiver perspective. Evidence emphasizes the importance of considering a bidirectional perspective (patient–caregiver) to understand better the pain experience throughout the cancer continuum and its consequences on QoL of patients and caregivers. Moreover, a holistic and multidimensional approach to cancer-related CP and its impact on QoL of patients and caregivers is still needed, in which the interconnection between physical, psychological, and social factors should be analyzed. Theoretical and methodological issues for orienting future social and family research initiatives were discussed.

The Effect of Narrative Nursing Intervention on Shame in Elderly Patients with Bladder Cancer after Ileal Bladder Replacement: A Cohort Study

Background

The standard treatment for bladder cancer (BC) is transurethral resection (TURBt), intravesical chemotherapy, and regular follow-up cystoscopy after surgery. However, some patients experience relapse or progression. Narrative care refers to a nursing model in which nurses put themselves into the patient's position through communication and listening, thereby alleviating the patient's negative emotions. This study analyzed narrative nursing interventions in elderly patients with BC after vesicoileal replacement.

Objective

To explore the positive stimulating effect of narrative nursing intervention on the sense of shame in elderly patients with bladder cancer (BC) after ileal bladder replacement.

Methods

A total of 60 elderly patients with BC who went through ileal replacement of the bladder from February 2019 to April 2021 in our hospital were enrolled. The patients were divided into the control group and the study group by the arbitrary number table method. The former group received routine care, and the latter group received a narrative nursing intervention model. The nursing satisfaction, stigma score, self-care ability score, SAS score, SDS score, and quality of life score were compared.

Results

First, we compared the nursing satisfaction. In the research group, 23 cases were very satisfied, 6 cases were satisfied, and 1 case was normal, and the satisfaction rate was 100.00%. In the control group, 13 cases were very satisfied, 8 cases were satisfied, 4 cases were general, and 5 cases were dissatisfied, with a satisfaction rate of 83.33%. The nursing satisfaction of the research group was significantly higher compared to that of the control group (P < 0.05). Secondly, we compared the stigma scores. The stigma scores of the study group at the time of discharge, 1 month, 3 months, and 6 months after discharge were lower compared to those of the control group (P < 0.05). In terms of the scores of self-care ability, the total scores of self-concept, self-care responsibility, self-care knowledge, self-care skills, and self-care ability of the research group were higher compared to those of the control group (P < 0.05). With regard to SAS scores, before nursing, there was no significant difference exhibited (P > 0.05). After nursing, the patient's SAS score decreased. Compared with the two groups, the SAS scores of the study group at discharge, 1 month, 3 months, and 6 months after discharge were all lower (P < 0.05). In terms of SDS score, there was no significant difference before nursing (P > 0.05). After nursing, the SDS scores of patients decreased. Compared between the two groups, the SDS scores of the study group at the time of discharge, 1 month, 3 months, and 6 months after discharge were lower (P < 0.05). Finally, we compared the life quality scores. Before nursing, there was no significant difference exhibited (P > 0.05). After nursing, the scores of life quality of patients improved. Compared with the two groups, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower compared to those of the control group (P < 0.05).

Conclusion

Narrative nursing can reduce anxiety and depression in elderly patients with BC after ileal replacement of the bladder, enhance the quality of life, reduce the patient's stigma, and play a positive motivating role. This nursing model is worthy of promotion in clinic.

Effect of individualized psychological intervention on negative emotion and sleep quality of patients after bladder cancer surgery: a randomized controlled trial

Background

Bladder surgery has a negative impact on patients' mental health, sleep quality. Conventional nursing interventions failed to meet the clinical needs. Therefore, this parallel-group RCT was performed to assess the effect of individualized psychological intervention on patients' negative emotions and sleep quality after bladder cancer surgery.

Methods

Patients with bladder cancer admitted to our hospital (from September 2018 to October 2020) and underwent surgical treatment were selected as the research objects. They were randomly allocated to a parallel control group or observation group based on a computer-generated random numbers table. Because our study included behavioral intervention, blinding was not possible for participants and care givers. The control group received conventional nursing care, and the observation group received strengthened individualized psychological intervention under the nursing measures of the control group. Sleep quality, anxiety, depression, nursing compliance, and the occurrence of bladder spasm were compared between the two groups.

Results

Seventy-eight eligible patients were included and randomly divided in two groups (n=39 for each group). The intervention procedure was completed without losses and exclusions of patients after randomization. Before the intervention, the Pittsburgh Sleep Quality Index Scale and the anxiety and depression scores were comparable between the two groups (P>0.05). After the intervention, the data of the two groups were significantly improved. The sleep quality, sleep time, sleep efficiency, the time to fall asleep, hypnotic drugs, sleep disorders, daytime dysfunction, anxiety score, and depression score of the observation group were lower than those of the control group, with significant differences (P<0.05). The total nursing compliance rate of the observation group reached 100.00%, which was higher than the control group. The difference between the groups was significant (P<0.05). There was no significant difference in the incidence of bladder spasm between the two groups (P>0.05).

Conclusions

Individualized psychological intervention applied to bladder cancer surgery can effectively improve patients' negative emotions and improve their sleep quality.

Trial registration

Chinese Clinical Trial Registry ChiCTR2100046468.

Coping With Oral Tongue Cancer and COVID-19 Infection

To date, April 19, 2021, the coronavirus disease 2019 (COVID-19) caused about 140,886,773 confirmed cases and more than 3,000,000 deaths worldwide since the beginning of the pandemic. Oncology patients are usually frail due to the fear of prognosis, recurrence, and outcomes of treatments. Thus, coping with cancer is a complicated process that is necessary to overcome oncological challenge, even more in case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) disease. This is a brief case report on a middle-aged man affected by advanced oral tongue cancer and COVID-19, describing his experience of cancer diagnosis, surgical treatment, and rehabilitation during the hospital quarantine for COVID-19. Besides the traumatic experience due to the functional alteration in breathing, eating, and speaking caused by major surgery and the concurrent facial disfigurement, our patient had to face a COVID-19 diagnosis, which implied hospital and social isolation. The aim of this perspective work is to focus on the role of the psychological support in the management of hospital distress related to COVID-19 psychophysical loneliness or alienation. In our experience, such support should anticipate patients' oncological surgery or treatment and should be implemented through telemedicine in case of isolation or after hospital discharge.