The Effects Of Psychological Intervention On Patients Who Received Intravesical Therapy After The Resection Of Bladder Cancer

Background:Bladder cancer is a common malignancy of the urinary system. According to the depth of tumor invasion, bladder cancer is divided into non-muscle invasive tumor and muscle invasive tumor. Currently, the treatment of the non-muscle invasive bladder cancer is transurethral resection. Studies showed that about 10-70% of patients would get a tumor recurrence after operation, of which 20-30% would eventually develop into muscle invasive bladder cancer. Intravesical therapy is the most effective treatment to reduce the recurrence rate of bladder cancer. However,most of patients who received intravesical therapy will get tensions, anxiety, depression and other psychological problems during the procedures. Lack of knowledge, impatience to the treatment procedures, pains caused by catheterization and the chemotherapy drug-induced side effects are the major reasons. Researchs showed that effective psychological intervention can significantly improve the patient's mental function, improve patient quality of life. There were few reports about the effects of psychological intervention on patients who receive intravesical therapy after the resection of bladder tumor. This study will evaluate the effects of psychological intervention in reducing anxiety, depression and other mood problem on patients who receive intravesical therapy. Objective:The present study was designed to find out an effective psychological intervention and make it as a part of standard treatment of bladder cancer. In addition, the differences of effects on different gender, age, educational level and living area will also be evaluated.Methods:80 consecutive patients with non-muscle invasive bladder cancer were enrolled and the patients were randomly divided into experimental group A(n=40) and control group B(n=40). All the patients received transurethral resection of bladder cancer. Normal nursing care was given to group A and the psychological intervention was given to group B. Profile of mood states(POMS) was used to evaluate the mental status before intervention, and 6 weeks after intervention. Results:After 6 weeks intervention, the POMS scores of the two groups had apparently changed, but the changes in experimental group were significantly higher than the control group(P<0.05), the psychological intervention could change the mental status of patients. In the experimental group, the change of POMS scores had no statistically significant when stratified by sex and age. For patients who had a higher educational level, the change of POMS scores were more obviously. In addition, when compared the change stratified by living area, patients who lived in rural got a low POMS scores. The pain scores of the two groups were above 5 points before intervention. After intervention, the pain score of experimental group decreased to2.1±0.9 points, while the control group felt to 3.9±1.3 points, the differences between two groups were significant (P <0.05). The mean follow up time were 19.6 months, no patients dead. The relapse rate of experimental group was 35% compared to 47.5% of the control group, no difference was observed.Conclusion:Psychological intervention can reduce the psychological stress of the patients who receive intravesical treatment, and it can improve the quality of life of patients. The effects will be better for urban patients and patients with higher educational level. The psychological intervention can reduce the pain by catheterization during the procedure of introvesical treatment. Furthermore, the psychological intervention has a trend to reduce the relapse rate of the bladder cancer.