Non-Muscle Invasive Bladder Cancer Survivors Experience PTSD Symptoms

Non-muscle invasive bladder cancer (NMIBC) survivors may experience higher rates of post-traumatic stress disorder (PTSD) compared with the general population, highlighting an unmet need of assessment in these individuals, according to study results presented at the Oncology Nursing Society 44th Annual Congress.

“Bladder cancer is the fifth most common cancer in the U.S., and non-muscle-invasive bladder cancer (NMIBC) represents approximately 75% of newly diagnosed patients with bladder cancer,” the researchers wrote in the abstract. “Having a NMIBC diagnosis with high recurrence rates, and frequent surveillance cystoscopies followed by repeated treatment can be a risk factor for post-traumatic stress disorder symptoms, potentially resulting in negative effects on quality of life.”

Since the recurrence rate for this disease is 50%, patients must undergo surveillance with cystoscopies. The recommendation guidelines call for regular surveillance cystoscopies every three months for two years, followed by every six months for the next three years, and then once per year after that, explained Ahrang Jung, Ph.D., RN, postdoctoral research associate at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.

“That means over five years, non-muscle invasive bladder cancer survivors need up to 14 cystoscopies. That is a lot,” she said during her presentation. “Being diagnosed with a threatening illness is capable of causing PTSD. And a substantial amount of research has been conducted regarding PTSD in cancer populations.”

Therefore, in a cross-sectional, descriptive population-based survey, the researchers aimed to examine the prevalence of PTSD and to identify predictive factors associated with it among NMIBC survivors recognized through the North Carolina Central Cancer Registry. The survey collected patient demographics and clinical characteristics, PTSD checklist for DSM-5 (PCL-5) scores and PROMIS applied cognition abilities.

Of the 376 responders available for evaluation, the majority were male (72.3%), white (94.4%) and a median age of 72 years (range, 39-94). In addition, patients were a median 3.4 years out from their original diagnosis when they responded to the survey.

The average score for PCL-5 was 7.1 on a range of zero to 66 (with higher scores indicating more PTSD symptoms). Moreover, using the DSM-5 symptom cluster severity score —

which included intrusion, avoidance, negative cognitions and moods, and arousal — 5.3% of participants met the provisional PTSD diagnosis. In total, 28.7% of responders met the criteria for and experienced at least one PTSD symptom cluster. “This is more than expected from the general population and other cancers,” Jung said.

After the researchers controlled for other variables, they found significantly higher PTSD symptoms among those who were younger, were not cured or did not know whether they were cured, had more comorbidities, had lower social support and had higher general cognitive concerns. Jung noted that PTSD did not significantly vary by sex, race/ethnicity, receipt of transurethral resection of the bladder tumor or cognition ability.

“Health care providers should be mindful of this possibility when planning and delivering care,” Jung said. “Specifically, assessment and management of PTSD symptoms are needed for NMIBC survivors in the survivorship phase of care. Those experiencing PTSD symptoms should be referred for counselling. Also, in future research, approaches to prevent the PTSD symptoms need to be developed.”