We observed that patients with urologic cancer would suffer from physical and psychological discomforts after diagnosis and these symptoms might be associated with the misunderstandings of the disease. Our study indicated that simply distributing proper propaganda materials could significantly impact several aspects, including relieving the symptoms of sleep disturbance, appetite loss and fatigue. In subgroup analysis, patients with renal cancer and patients no more than 57 years old were more likely to benefit from the intervention.
Generally, the scores of symptoms were low and those of five types of functions were high, indicating relatively good QoL of our patients. Detailly speaking, sleep disturbance, fatigue, pain and financial difficulties were the most distressing issues. The scores of emotional function, physical function and global QoL were relatively low. Previous studies supported our findings. A large population-based study consisting of 266505 cases showed low physical function, distress and reduced QoL were more common among cancer patients than in people without cancers(15). Particularly, Shin et al. compared the QoL of 331 urologic cancer survivors and 1177 healthy subjects. They found that prostate and bladder cancer survivors had significantly lower appetites than the controls, while renal cancer survivors had lower physical function scores and greater pain(16). Besides, they also reported that the percentage of financial difficulties of urologic cancer survivors was higher than that in controls(16). Beisland et al. demonstrated that long-term survivors after renal cancer treatment had worse scores on fatigue, pain, sleep, nausea and vomiting, constipation and diarrhea than other groups(17). All of these findings were consistent with ours, making our results more reliable.
Moreover, emotional issues could not be neglected since they can closely associate with physical symptoms. A systematic review revealed fatigue often came with pain, sleep problems and emotional distress, and therefore they became a symptom cluster exhibiting in various cancer types, such as urologic cancer and breast cancer(18, 19). Ho et al. further considered fatigue as a potential intervention target because fatigue may lead to depression(19). A mini-review reported that the prevalence of distress among patients with renal, bladder and prostate cancer were 20%, 12% and 30%, respectively(20). Another study found that the prevalence of depression, anxiety and post-traumatic stress disorder among patients with newly diagnosed bladder or renal cancer was 77.5%, 69.3% and 25.2%, respectively(21). It should be alerted that the clinical team needs to emphasize the importance of total care of not only physical symptoms but also psychological problems.
Our study showed that most of the parameters of QLQ-C30 did not elicit statistical differences among patients with different cancer before and after the intervention. However, patients with renal cancer might receive a more significant benefit from the intervention than patients with bladder or prostate cancer. Although not reaching statistically significant, constipation, except for the aforementioned symptoms, was also relieved after the intervention among patients with renal cancer. The mean age of them was the youngest among the three groups. Younger age is often related to better strength, less frailty and quicker rehabilitation, resulting in higher rates of QoL improvement(22). We reckon that due to younger age, renal cancer patients can adapt themselves more quickly and face the challenges more positively. Patients with bladder cancer had significant improvement in role function. Role function is closely related to physical strength. The reasons for this are still unknown. Studies with a large cohort are warranted in the future.
When conducting subgroup analyses by age, it was clear that younger patients elicited significant improvement after intervention. Novara et al. demonstrated that younger age was related to shorter recovery time to return to the baseline level of physical and emotional domains in renal cancer(23). Parker et al. founded younger renal cancer patients showed less fear of recurrence than older patients(24). As for prostate cancer patients, Chambers et al. indicated that age played an important role in patients' survival and functional status(25). These findings were in line with ours. In contrast, Kretschmer et al. and Normann et al. revealed no significant impact on QoL after receiving radical cystectomy and either ileal conduit or orthotopic neobladder regarding age at operation(26, 27). The differences in baseline characteristics might explain the discrepancy. Nevertheless, age is a negligible factor of QoL and survival. The clinical team should choose an optimal strategy based on age.
Our propaganda materials consist of the general treatment procedures, common adverse events, solutions of adverse events and tips on maintaining health. Together with face-to-face doctor-patient communications, it allows patients to gain a complete view of cancer treatment strategies, knowing what it is and what to do when an inexperienced event occurs. Thus, it dissolves the nagging lump of tension. Fatigue, sleep problem, appetite and physical fitness are associated with emotional issues more or less. It is unsurprising that distributing propaganda materials could exert significant impacts on QoL.
Our studies had several limitations. This study was meant to investigate the influence of the intervention among patients with different kinds of urologic cancer, so we did not evaluate its impact on patients with the same kind of cancer but different TNM stages. We could not make comparisons according to the educational backgrounds, economic levels and marital status due to the low response rates of these questions. The numbers of patients with bladder or prostate cancer were relatively small compared to renal cancer patients.