Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcinoma

Rami Ajaj, Jaime Omar Herrera Cáceres, Alejandro Berlin, Christopher J.D. Wallis, Thenappan Chandrasekar, Zachary Klaassen, Ardalan E. Ahmad, Ricardo Leao, Antonio Finelli, Neil Fleshner, Hanan Goldberg

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: To analyze gender-based differences in distress symptoms in patients with non-metastatic renal cell carcinoma (RCC) at different stages of disease. Methods: The Edmonton Symptom Assessment System—revised (ESAS-r) questionnaire includes a physical (PHSDSS) and a psychological distress sub-score (PDSS). The ESAS-r was used to measure psychological and physical distress symptoms in localized RCC patients in a major cancer referral center between 2014 and 2017 at four predefined time points: (a) diagnosis, (b) biopsy, (c) surgery, and (d) last follow-up. Results were gender stratified, and multivariable linear regression models were used to determine associations with increased sub-scores. Results: Overall, 495 patients were included with 37.2% females. No significant gender differences were seen in mean age, relevant clinical parameters, and treatment. PDSS was significantly higher in females after diagnosis (8.5 vs. 5.1, p = 0.018), biopsy (8.9 vs. 4.1, p = 0.003), and surgery (6.5 vs. 4.4, p = 0.007), while being similar at the last follow-up. The multivariable model demonstrated a statistically significant association of female gender with higher PDSS after diagnosis (B = 3.755, 95% CI 0.761–6.750), biopsy (B = 6.076, 95% CI 2.701–9.451), and surgery (B = 1.974, 95% CI 0.406–3.542). PHSDSS was significantly higher in females after biopsy (10.0 vs. 5.7, p = 0.028) and surgery (8.6 vs. 6.1, p = 0.022). In the multivariable model, female gender conferred a higher PHSDSS only after surgery (B = 2.384, 95% CI 0.208–4.560). Conclusions: Gender-associated psychological distress differences exist in non-metastatic RCC patients throughout treatment, while dissipating at last follow-up. Emphasis should be placed on screening for distress symptoms and providing psychological support continuously, particularly for female patients.

Original languageEnglish (US)
Pages (from-to)2547-2554
Number of pages8
JournalWorld Journal of Urology
Issue number10
StatePublished - Oct 1 2020


  • Edmonton Symptom Assessment System
  • Gender
  • Physical distress
  • Psychological distress
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Urology


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