The patient with bladder cancer. From symptoms, through treatment, with special reference to psychosocial consequences of radical cystectomy

Sammanfattning: Factors determining patient`s and doctor`s delay in diagnosis of bladder cancer were type of initial symptoms, level of health service first consulted and number of steps in the referral system. No correlation was found between psychosocial factors and patient`s delay. In retrospective studies after cystectomy for bladder cancer, patients with continent cutaneous diversion of urine had fewer stoma-related problems than those with conduit diversion, but sexual dysfunction, disturbed partner relationships and emotional problems, which were common, did not differ between these groups. Psychological support was seldom provided by medical personnel. Despite the patients` high acceptance level of the malignancy, inability to accept their present condition was common. Prospective studies were performed to assess the influence of psychological defence mechanisms as evaluated with MCT-test and of mood, general philosophical outlook and type of urinary tract reconstruction on risk of psychosocial complications after cystectomy, and also the importance of early psychosocial intervention. Preoperative MCT-test had low value for predicting risk of such complications in patients studied 3 and 12 months postoperatively, but at 5 years "risk" patients expressed lower self-esteem and greater difficulties in interpersonal contact-seeking. Patients who postoperatively ascribed their life`s course to non-personal factors and who believed in a deity or a supernatural power tended to do poorly after surgery. With regard to method of reconstruction, patients with orthotopic bladder replacement adjusted less well. Psychosocial intervention did not influence emotional adaptation a 3-month follow-up, but was helpful in patients with continent cutaneous diversion. Defensive strategies and philosophical outlook did not by and large influence the outcome of intervention.