Non-muscle invasive bladder cancer (NMIBC) survivors may experience higher rates of post-traumatic stress disorder (PTSD) compared with the general population—highlighting the need for nurses to assess and manage these symptoms, according to study results presented at the Oncology Nursing Society (ONS) 44th Annual Congress.
Since the recurrence rate for this disease is 50%, patients must undergo surveillance with cystoscopies. The recommendation guidelines call for regular surveillance cystoscopies every 3 months for 2 years, followed by every 6 months for the next 3 years, and then once per year after that, explained Ahrang Jung, PhD, RN, postdoctoral research associate at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.
“That means over 5 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.”
Jung noted that recent evidence has suggested that cancer might be experienced as a traumatic event by some with cancer, which can range from 7% to 14%—a rate that is higher than the general adult population. “Having a non-muscle invasive bladder cancer diagnosis, high recurrence rates, and frequent surveillance cystoscopies followed by repeated treatment can be a risk factor for PTSD symptoms. And these symptoms might affect survivors’ quality of life,” Jung said.
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 2000 randomly selected patients, 398 returned their surveys (response rate, 23.6%), of which 22 were incomplete and excluded from analysis.
Among the remaining 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 (SD = 10.9) on a range of 0 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 1 PTSD symptom cluster.
In particular, PTSD symptoms had significant associations with age at study enrollment, current disease status, comorbidity number, social support, and general cognitive concerns. After the researchers controlled for other variables, they found significantly higher PTSD symptoms among those who were younger (P
<.01), were not cured or did not know whether they were cured (P
<.001, had more comorbidities (P
<.001), had lower social support (P
<.05), and had higher general cognitive concerns (P
<.001). Jung noted that PTSD did not significantly vary by sex, race/ethnicity, receipt of transurethral resection of the bladder tumor, or cognition ability.
“Although NMIBC survivors are considered as early stage, 28.7% of them may be experiencing PTSD symptoms. This is more than expected from the general population and other cancers,” Jung said. “Therefore, healthcare providers should be mindful of this possibility when planning and delivering care. 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.”
Jung A, Crandell J, Nielsen M, Mayer D. Post-Traumatic Stress Disorder in Non-Muscle-Invasive Bladder Cancer Survivors. Presented at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA. Abstract 5224