Henningsohn Lars, Wijkström Hans, Steven Kenneth, Pedersen Jörgen, Ahlstrand Christer, Aus Gunnar, Kallestrup Else Brohm, Bergmark Karin, Onelöv Erik, Steineck Gunnar
Department of Oncology, Radiumhemmet, Z:6, Karolinska Institute, Box 4402, S-102 68, Stockholm, Sweden.
Eur Urol. 2003 Jun;43(6):651-62. doi: 10.1016/s0302-2838(03)00135-0.
The influence of specific symptoms on emotions and social activities in the individual patient varies. Little is known about this variation in urinary bladder cancer survivors (in other words, about the relative importance of sources of symptom-induced distress).
We attempted to enroll 404 surgical patients treated with cystectomy and a conduit or reservoir in four Swedish towns (Stockholm, Orebro, Jönköping, Linköping), 101 surgical patients treated with cystectomy and orthotopic neobladder at the Herlev Hospital in Copenhagen, Denmark, and 71 patients treated with radical radiotherapy for bladder cancer, as well as 581 men and women controls in Stockholm and Copenhagen. An anonymous postal questionnaire was used to collect the information.
A total of 503 out of 576 (87%) treated patients and 422 out of 581 (73%) controls participated but 59 patients were excluded. The primary source of self-assessed distress among cystectomised patients was compromised sexual function; reduced intercourse frequency caused great distress in 19% of the conduit patients, 20% of the reservoir patients and 19% of the bladder substitute patients. The primary source of self-assessed distress in patients treated with radical radiotherapy was symptoms from the bowel; 17% reported great distress due to diarrhoea, 16% due to abdominal pain, 14% due to defecation urgency and 14% due to faecal leakage. The highest proportion of subjects being distressed was 93% (substantial: 43%, moderate: 29% and little: 21%) for treated upper or lower urinary retention (indwelling catheter or nephrostomy).
The distress caused by a specific symptom varies considerably and the prevalence of symptoms causing great distress differs between treatments in bladder cancer survivors. It is possible that patient care and clinical research can be made more effective by focusing on important sources of symptom-induced distress.
特定症状对个体患者情绪和社交活动的影响各不相同。对于膀胱癌幸存者的这种差异（即症状引发痛苦的来源的相对重要性），我们了解甚少。
我们试图招募在瑞典四个城镇（斯德哥尔摩、厄勒布鲁、延雪平、林雪平）接受膀胱切除术并采用导管或贮尿囊治疗的404例手术患者、在丹麦哥本哈根的赫勒夫医院接受膀胱切除术并采用原位新膀胱治疗的101例手术患者、71例接受膀胱癌根治性放疗的患者，以及斯德哥尔摩和哥本哈根的581名男女对照者。通过一份匿名邮寄问卷收集信息。
576例接受治疗的患者中有503例（87%）、581例对照者中有422例（73%）参与，但59例患者被排除。膀胱切除患者自我评估痛苦的主要来源是性功能受损；性交频率降低给19%的导管患者、20%的贮尿囊患者和19%的膀胱替代患者带来极大痛苦。接受根治性放疗患者自我评估痛苦的主要来源是肠道症状；17%的患者称腹泻带来极大痛苦，16%称腹痛，14%称排便急迫，14%称粪便泄漏。接受治疗的上尿路或下尿路潴留（留置导尿管或肾造瘘）患者中感到痛苦的受试者比例最高，为93%（严重：43%，中度：29%，轻微：21%）。
特定症状引起的痛苦差异很大，膀胱癌幸存者中不同治疗方法导致极大痛苦的症状发生率也不同。通过关注症状引发痛苦的重要来源，有可能提高患者护理和临床研究的效果。
