Introduction: The recurrence rate for bladder cancer is high. Over 30% of those with muscle invasive bladder cancer have a recurrence within 5 years representing a source of persistent anxiety and distress. Fear of cancer recurrence (FCR) is well characterized in other malignancies such as breast, thyroid, and brain cancers. It has been characterized in prostate, renal, and testis cancer. This study describes the prevalence and impact of FCR among patients with bladder cancer who have had cystectomy.
Methods: A phone survey was conducted using the Fear of Cancer Recurrence-7 index in patients who had previously undergone radical cystectomy for bladder cancer. From the period of 2015 to 2020, 145 patients were eligible to undergo the phone survey. 75 patients agreed to being surveyed. We evaluated patients based on factors such as time since surgery, clinical and pathologic stage, receipt of neoadjuvant chemotherapy, ASA status, and length of stay.
Results: The median age for participants was 70. 83% of respondents were male. 84% of respondents were white. 39 patients had muscle invasive disease at presentation and 17 patients had muscle invasive disease on pathologic staging. Median time since surgery was 28 months. 17% of patients had high (FCR7=17) scores. Those with lower clinical and pathologic stage disease had higher FCR7 scores. 12/58 (21%) patients with =PT1 reported a high FCR while only 1/17 (6%) of patients with =pT2 disease reported high FCR (p=0.11). Their FCR7 score was more likely to be =17 in the 2nd or 3rd year from surgery. Patients who underwent Indiana Pouch urinary diversion were more likely to have a FCR7=17 when compared to ileal conduit or Studer neobladder (44.4% vs 13.6%, p=0.022).
Conclusions: Fear of cancer recurrence in patients with bladder cancer is a phenomenon that should be considered when counseling patients in the preoperative as well as surveillance stages of their cancer care. Even after several years, patients who have FCR continue to exhibit persistent fear. Patients with certain forms of urinary diversion may also have differing FCR. Though not statistically significant, patients with lower stage disease may require closer psychologic monitoring through their cancer treatment journey.