Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcin
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ORIGINAL ARTICLE
Gender‑based psychological and physical distress differences in patients diagnosed with non‑metastatic renal cell carcinoma Rami Ajaj1 · Jaime Omar Herrera Cáceres1 · Alejandro Berlin2,3 · Christopher J. D. Wallis1,4 · Thenappan Chandrasekar5 · Zachary Klaassen6,7 · Ardalan E. Ahmad1 · Ricardo Leao1 · Antonio Finelli1 · Neil Fleshner1 · Hanan Goldberg1,8 Received: 7 September 2019 / Accepted: 12 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Edmonton Symptom Assessment System · Gender · Psychological distress · Physical distress · Renal cell carcinoma
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-019-03057-2) contains supplementary material, which is available to authorized users. * Hanan Goldberg [email protected] 1
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Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada Techna Institute, Uni
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