Emerging Gender-Based Differences In the Psychosocial Needs of Bladder Cancer Survivors

Background and Purpose: Bladder cancer is the fifth most common cancer in the U.S. Approximately 70,000 new cases of bladder cancer are diagnosed annually, with 75% being nonmuscle-invasive (NMIBC). Men are 3-4 times more likely to receive a bladder cancer diagnosis; women and African Americans are more likely to be diagnosed at later stages and have greater morbidity and mortality. While there are currently more than 500,000 U.S. bladder cancer survivors, little is known about the survivorship needs of this population. The present phenomenological qualitative study explored the “lived experiences” of bladder cancer survivors in an effort to identity potential clinically-modifiable factors influencing diagnosis, treatment, symptom management, and health-related quality of life (HRQOL).

Methods: Semi-structured interviews were conducted with a convenience sample of 26 NMIBC patients recruited from a VA Medical Center and an affiliated private hospital in the Southwestern U.S. Consistent with NMIBC epidemiology, participants were primarily older (M=69.1 years, SD=9.4 years), male (84.6%), and Caucasian (80.8%). Participants were also predominately high school graduates/some college (92.3%) and married or in long-term relationships (73.2%). Interviews were audiotaped and averaged one hour and six minutes in length. Recordings were transcribed verbatim and analyzed using holistic-content and constant comparative analyses.

Results: Qualitative findings reveal gender-based differences in survivors' experiences along several dimensions affecting HRQOL. These include previous cancer experiences; NMIBC treatment and symptom management; impact on activities of daily living and caregiving; and body image and intimacy. Higher proportions of male participants reported having previous primary cancers than their female counterparts. However, female participants diagnosed with NMIBC were more likely to undergo radical cystectomy (i.e., bladder removal). Female participants more frequently spoke about symptoms impacting their ability to care for themselves, their homes, and families. In contrast, men more frequently emphasized the impact their disease and resulting symptoms had on their ability to perform work outside the home or to participate in hobbies. When speaking about their NMIBC diagnosis and its impact on sexuality and intimacy, male participants primarily emphasized changes in sexual functioning whereas women also spoke about changes in body image and sexual desirability.

Conclusions and Implications: Although known health disparities exist in NMIBC diagnosis, treatment, and survival rates, relatively little is known about the psychosocial needs of NMIBC survivors. Our findings represent some of the first attempts to explore experiences affecting HRQOL within this population. Social work practitioners are well-equipped to address male and female NMIBC survivors' needs for patient navigation, psychological counseling, and survivorship care plans. Future social work and behavioral research should focus on designing and implementing disease-specific education and symptom management interventions targeting the unique needs of this survivorship population and tailored to accommodate gender-based differences.