Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcinoma

Rami Ajaj, Jaime Omar Herrera Cáceres, Alejandro Berlin, Christopher J.D. Wallis, Thenappan Chandrasekar, Zachary Klaassen, Ardalan E. Ahmad, Ricardo Leao, Antonio Finelli, Neil Fleshner, Hanan Goldberg

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Abstract

Objectives: To analyze gender-based differences in distress symptoms in patients with non-metastatic renal cell carcinoma (RCC) at different stages of disease. Methods: The Edmonton Symptom Assessment System—revised (ESAS-r) questionnaire includes a physical (PHSDSS) and a psychological distress sub-score (PDSS). The ESAS-r was used to measure psychological and physical distress symptoms in localized RCC patients in a major cancer referral center between 2014 and 2017 at four predefined time points: (a) diagnosis, (b) biopsy, (c) surgery, and (d) last follow-up. Results were gender stratified, and multivariable linear regression models were used to determine associations with increased sub-scores. Results: Overall, 495 patients were included with 37.2% females. No significant gender differences were seen in mean age, relevant clinical parameters, and treatment. PDSS was significantly higher in females after diagnosis (8.5 vs. 5.1, p = 0.018), biopsy (8.9 vs. 4.1, p = 0.003), and surgery (6.5 vs. 4.4, p = 0.007), while being similar at the last follow-up. The multivariable model demonstrated a statistically significant association of female gender with higher PDSS after diagnosis (B = 3.755, 95% CI 0.761–6.750), biopsy (B = 6.076, 95% CI 2.701–9.451), and surgery (B = 1.974, 95% CI 0.406–3.542). PHSDSS was significantly higher in females after biopsy (10.0 vs. 5.7, p = 0.028) and surgery (8.6 vs. 6.1, p = 0.022). In the multivariable model, female gender conferred a higher PHSDSS only after surgery (B = 2.384, 95% CI 0.208–4.560). Conclusions: Gender-associated psychological distress differences exist in non-metastatic RCC patients throughout treatment, while dissipating at last follow-up. Emphasis should be placed on screening for distress symptoms and providing psychological support continuously, particularly for female patients.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • Edmonton Symptom Assessment System
  • Gender
  • Physical distress
  • Psychological distress
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Ajaj, R., Cáceres, J. O. H., Berlin, A., Wallis, C. J. D., Chandrasekar, T., Klaassen, Z., Ahmad, A. E., Leao, R., Finelli, A., Fleshner, N., & Goldberg, H. (Accepted/In press). Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcinoma. World Journal of Urology. https://doi.org/10.1007/s00345-019-03057-2