Savin Ziv, Dekalo Snir, Ben Dayan Liron, Yossepowitch Ofer, Mabjeesh Nicola J
Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
Can Urol Assoc J. 2024 Mar 1. doi: 10.5489/cuaj.8611.
We aimed to assess rates of depression in patients with bladder cancer undergoing radical cystectomy and identify its predictors.
Depressive symptoms in 42 consecutive patients were evaluated using the Beck's Depression Inventory (BDI) on the day prior to surgery, postoperative day (POD) 6, six weeks after surgery, and 12-18 months postoperatively.
Fifteen patients (36%) presented with BDI scores ≥10 before the operation; this rate increased to 64% on POD 6 and 69% at six weeks post-surgery. Depression score rose from a preoperative median of 7 to 11 on POD 6 (p=0.003) and to 15 at six weeks after surgery (p=0.001). Patients who arrived with BDI score of <10 had a higher increase in the BDI at six weeks compared to patients with depressive symptoms prior to surgery (average increase 9.8 vs. 0.8, p<0.01). Age, gender, type of diversion, and complications were not associated with depression at presentation or progression of depression. Patients who did not receive neoadjuvant chemotherapy tended to be at increased risk for depression progression (57.1% vs. 14.3%, p=0.093). Twenty-four patients completed a fourth questionnaire 12-18 months postoperatively. Median BDI score was 8; three patients with disease recurrence had a higher increase in the BDI score (average 12.7 vs. -5.2, p<0.01).
Depression among patients facing cystectomy is high and postoperative progression is substantial. Patients without depressive symptoms preoperatively are at increased risk of developing postoperative depression. After 12-18 months, the most influential risk factor for depression is recurrence. These findings highlight the need to consider interventions in selected patients.
我们旨在评估接受根治性膀胱切除术的膀胱癌患者的抑郁发生率，并确定其预测因素。
连续42例患者在手术前一天、术后第6天、术后六周以及术后12 - 18个月，使用贝克抑郁量表（BDI）评估抑郁症状。
15例患者（36%）在手术前BDI评分≥10；该比例在术后第6天升至64%，术后六周时为69%。抑郁评分从术前中位数7分升至术后第6天的11分（p = 0.003），术后六周时升至15分（p = 0.001）。术前BDI评分<10的患者在六周时BDI升高幅度高于术前有抑郁症状的患者（平均升高9.8分对0.8分，p<0.01）。年龄、性别、改道类型和并发症与抑郁的出现或抑郁进展无关。未接受新辅助化疗的患者抑郁进展风险往往增加（57.1%对14.3%，p = 0.093）。24例患者在术后12 - 18个月完成了第四份问卷。BDI评分中位数为8分；三名疾病复发患者的BDI评分升高幅度更大（平均12.7分对 - 5.2分，p<0.01）。
面临膀胱切除术的患者中抑郁发生率高且术后抑郁进展显著。术前无抑郁症状患者术后发生抑郁的风险增加。术后12 - 18个月，抑郁最有影响力 的风险因素是复发。这些发现凸显了对特定患者考虑采取干预措施的必要性。
