Age Differences in Patient-reported Psychological and Physical Distress Symptoms in Bladder Cancer Patients – A Cross Sectional Study

Objective: To assess age-based differences in psychological and physical symptoms of bladder cancer (BC) patients at different disease stages. Methods: This was a cross-sectional single-center retrospective study between 2014 and 2017, assessing BC patients at different time points of their disease trajectory, after completing the Edmonton Symptom Assessment System-revised questionnaire. The questionnaire was filled at 3 predefined time points: (a) following diagnosis, (b) after radical cystectomy (RC), and (c) at last follow-up. The Edmonton Symptom Assessment System-revised consists of the physical distress sub-score (PHSDSS), entailing scores of 6 physical symptoms, and the psychological distress sub-score (PDSS), entailing scores of 3 psychological symptoms. Patients were stratified to those younger and older than 65 years. Multivariable linear regression models assessed predictors of increased PDSS and PHSDSS. Results: A total of 232 patients were analyzed. No significant baseline clinical differences were demonstrated between both groups, excepting a higher Charlson comorbidity score (4.85 vs 3.87, P =.004), and a higher rate of muscle-invasive disease (71.7% vs 52.1%, P =.008) in older patients. PHSDSS scores remained similar throughout all time points in both groups. In contrast, younger patients had a significantly higher PDSS score at diagnosis, and after RC. Multivariable models demonstrated that an increased PDSS score (B = 2.372, 95% CI 0.36-4.385) was more likely in younger patients at diagnosis and after RC. An increased PHSDSS (B = 5.118, 95% CI 0.462-9.774) was more likely in younger patients only after RC. Conclusion: Younger BC patients may benefit from access to psychological support services as part of a comprehensive treatment regimen, especially after diagnosis and RC.