Distress screening in patients with urogenital malignancies.

Abstract

412 Background: Malignant tumors do not only have a somatic but also a psychological impact on patients. To date, only a few studies are available which evaluated the potential psychological burden of patients suffering from urogenital cancers. In this prospective, longitudinal study we examine the baseline psychological distress of patients treated for urogenital malignancies focussing on testicular cancer (TC) and prostate cancer (PCA). Methods: Psychological distress of 192 inpatients treated for urogenital malignancies was evaluated using the distress thermometer (DT), an established tool for the detection of distress, prior to any surgical or systemic therapy. The DT consists of a visual analogue scale ranging from 0 to 10 resulting in a low (0-3), moderate (4-6) or high (7-10) stress level. Furthermore, it contains a 36-item list of problems subdivided into 5 categories (practical, family, emotional, spiritual/religious, physical). Results: The mean DT score was 5 (interquartile range (IQR) 3-7) with the most common stressors being of emotional origin, namely fear (50%), worry (44%), nervousness (42%), sleep disorders (39%) and fatigue (32%). DT analysis did not reveal any difference between the tumor entities but 64% of all patients displayed a moderate to high stress level requiring psycho-oncological support. The comparison of PCA and TC demonstrated a higher distress level in PCA patients in the subgroups of metastatic disease (median 5.5, IQR 4-8 vs. median 4, IQR 2-6; p = 0.018), secondary therapy (median 6, IQR 5-8 vs. median 4.5, IQR 2.75-6; p = 0.023) and salvage treatment (median 7, IQR 4.5-9 vs. 5, IQR 2.75-6; p = 0.021). PCA patients receiving salvage treatment displayed significantly higher distress levels compared to non-salvage treated patients (median 7, IQR 4.5-9 vs. median 5, IQR 2-7; p 0.028). Conclusions: Our study shows that 64% of urological tumor patients should be offered psycho-oncological support. Especially patients suffering from advanced stage PCA seem to have a high stress level. Thus, physicians in the field of urologic oncology should be aware of their patients’ psychological distress in order to identify high-risk patients and provide them with an appropriate psycho-oncological support.