A longitudinal investigation of patients' return to work, health-related quality of life, and psychological stress during bladder cancer perfusion

Purpose: To evaluate the changes in and relationships between return to work (RTW), health-related quality of life (HRQoL), and Psychological Stress in patients with non-invasive bladder cancer during bladder perfusion therapy after electrosurgical resection. Design: In this prospective observational study Methods: Patients who underwent bladder perfusion after resection for non-muscular-invasive bladder cancer between August 2021 and July 2023 were enrolled in a third class A hospital in Shanghai. Health-related quality of life and psychological stress were assessed using a Standardized Questionnaire of the European Organization for Cancer Research and Treatment (EORTC-QLQ-C30) and the Chinese Cancer Patient Stress Questionnaire (CPSS) at the beginning of induced bladder perfusion (T1), end of induced bladder perfusion (T2), 6 months of maintenance bladder perfusion (T3), and 12 months of maintenance bladder perfusion (T4). The data of patients returning to work were recorded at T3 and T4, and the change rule and correlation between the three were analyzed longitudinally. Findings: A total of 426 patients underwent bladder perfusion after electroresection for non-muscular invasive bladder cancer and 230 patients were employed before surgery (53.99%). At T1, the HRQoL in both groups was at a low level, and during T1-T4, HRQoL in both groups was in a dynamic process of change and gradually improved. At T4, HRQoL of RTW patients was higher than that of the non-RTW group, and RTW could improve THE HRQoL of patients. At T1, the psychological pressure in both groups was at a high level, and gradually decreased during T1-T3, but at T3 and T4, 50.0% and 51.0% patients had high psychological pressure. At T4, the number of patients with high psychological pressure in the RTW group was higher than that in the non-RTW group (P=0.019), and RTW led to increased psychological pressure in patients. In this study, the patients had a high RTW rate, with 200 (86.9%) and 184 (80.0%) returning to work at T3 and T4, respectively. Multivariate analysis showed that age≤58 years (OR:7.842;95%CI: 2.495-24.645; P <0.001) was a positive predictor of RTW at T4, and lymph node metastasis (OR, 0.220;95% CI: 0.054-0.893;P=0.034) was a negative predictor of RTW at T4. Conclusions: The HRQoL of all patients was low at the beginning of bladder perfusion therapy. With the extension of treatment period, the HRQoL of patients was in dynamic change and gradually improved, and RTW could promote the improvement of patients HRQoL.The overall RTW rate of patients with bladder perfusion was higher, but patients in the RTW group had higher psychological stress, so the monitoring of mental health and related symptoms should be strengthened in the future follow-up process, and psychological nursing support should be provided if necessary. Clinical Evidence: The supportive care needs of bladder perfusion patients at different time points were assessed, and corresponding interventions were taken to ensure the relevance of the intervention content.