{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:28:07Z","timestamp":1792477687325,"version":"4.5.0"},"reference-count":19,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with permanent alteration of body image and disability. Combined with the aggressive malignant potential of MIBC and considerable risk of complications, it poses a serious threat to the psychological well-being of patients. Educational deficiencies causing uncertainty and confusion aggravate surgery-related anxiety and may lead to depression along with further social disability. We conceived a preoperative supportive program named \u201cCystocare\u201d held by urologists, psychologists, stoma therapists and cancer survivors to facilitate patients\u2019 adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC. We included 95 consecutive patients who filled Hospital Anxiety and Depression Score questionnaires before RC and on discharge. The intervention arm (A) comprised 32 Cystocare participants. The remaining 63 patients who received standard preparation constituted the control arm (B). Whilst there were no differences in median anxiety and depression scores preoperatively, in postoperative measurement, the intervention arm showed a lower median depression score than controls: 3 vs. 8 points, p = 0.015. On multivariate analysis we confirmed lower risk of postoperative depression in Cystocare participants: OR = 0.215 (95%CI: 0.066\u20130.699), p = 0.011, along with lower odds of preoperative anxiety in patients undergoing laparoscopic RC: OR = 0.365 (95%CI: 0.136\u20130.978), p = 0.045, and higher risk of prolonged hospital stay in patients experiencing postoperative anxiety OR = 17.114 (95%CI: 1.283\u2013228.234) p = 0.032. Preoperative educational and supportive intervention complements laparoscopic RC in the alleviation of surgery-related anxiety and depression. The support group meetings provide an attractive and cost-effective opportunity to moderate emotional response in patients undergoing RC, and as such, deserve widespread adoption.<\/jats:p>","DOI":"10.3390\/ijerph182413071","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:28:11Z","timestamp":1639358891000},"page":"13071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Educational and Psychological Support Combined with Minimally Invasive Surgical Technique Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Undergoing Radical Cystectomy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1446-2970","authenticated-orcid":false,"given":"Artur","family":"Lemi\u0144ski","sequence":"first","affiliation":[{"name":"Department of Urology and Urological Oncology, Pomeranian Medical University, 71-899 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4898-960X","authenticated-orcid":false,"given":"Krystian","family":"Kaczmarek","sequence":"additional","affiliation":[{"name":"Department of Urology and Urological Oncology, Pomeranian Medical University, 71-899 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Ba\u0144carz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Pomeranian Medical University, 71-457 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Zakrzewska","sequence":"additional","affiliation":[{"name":"Department of Radiology, Independent Public Provincial Hospital, 71-455 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5933-3753","authenticated-orcid":false,"given":"Bartosz","family":"Ma\u0142kiewicz","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3679-7325","authenticated-orcid":false,"given":"Marcin","family":"S\u0142ojewski","sequence":"additional","affiliation":[{"name":"Department of Urology and Urological Oncology, Pomeranian Medical University, 71-899 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.eururo.2020.03.055","article-title":"European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines","volume":"79","author":"Witjes","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.eururo.2014.12.007","article-title":"Systematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy","volume":"67","author":"Novara","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_3","first-page":"531.e7","article-title":"Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices","volume":"34","author":"Mohamed","year":"2016","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1159\/000507094","article-title":"Quality of Patient Information by Urologists Is Associated with Mental Distress in Bladder Cancer Patients","volume":"43","author":"Mani","year":"2020","journal-title":"Oncol. Res. Treat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1097\/01.ju.0000141245.08456.1a","article-title":"Assessment of perioperative psychological distress in patients undergoing radical cystectomy for bladder cancer","volume":"172","author":"Palapattu","year":"2004","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.juro.2015.07.095","article-title":"Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical Cystectomy","volume":"195","author":"Sharma","year":"2016","journal-title":"J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.dhjo.2017.03.013","article-title":"A predictive model of anxiety and depression symptoms after a lower limb amputation","volume":"11","author":"Pedras","year":"2018","journal-title":"Disabil. Health J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.juro.2013.10.101","article-title":"The natural history of symptoms and distress in patients and families following cystectomy for treatment of muscle invasive bladder cancer","volume":"191","author":"Benner","year":"2014","journal-title":"J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/abm\/15.4.245","article-title":"Benefits of psychological preparation for surgery: A meta-analysis","volume":"15","author":"Johnston","year":"1993","journal-title":"Ann. Behav. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Burgess, L., Arundel, J., and Wainwright, T. (2019). The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review. Healthcare, 7.","DOI":"10.3390\/healthcare7010048"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1002\/cncr.29076","article-title":"Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial","volume":"121","author":"Stagl","year":"2015","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the Hospital Anxiety and Depression Scale: An updated literature review","volume":"52","author":"Bjelland","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ejon.2017.03.001","article-title":"Efficacy of preoperative uro-stoma education on self-efficacy after Radical Cystectomy; secondary outcome of a prospective randomized controlled trial","volume":"28","author":"Jensen","year":"2017","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e884","DOI":"10.5489\/cuaj.2025","article-title":"Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program","volume":"8","author":"Carli","year":"2014","journal-title":"J. Can. Urol. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ctrv.2017.03.012","article-title":"Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis","volume":"56","author":"Okuyama","year":"2017","journal-title":"Cancer Treat. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ay, A.A., Ulucanlar, H., Ay, A., and Ozden, M. (2014). Risk factors for perioperative anxiety in laparoscopic surgery. J. Soc. Laparoendosc. Surg., 18.","DOI":"10.4293\/JSLS.2014.00159"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1213\/ANE.0000000000003910","article-title":"Relationship Between Preoperative Antidepressant and Antianxiety Medications and Postoperative Hospital Length of Stay","volume":"128","author":"Vashishta","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.7812\/TPP\/15-022","article-title":"Anxiety\u2019s Impact on Length of Stay Following Lumbar Spinal Surgery","volume":"19","author":"Floyd","year":"2015","journal-title":"Perm. J."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13071\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:45:26Z","timestamp":1760168726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,11]]},"references-count":19,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182413071"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182413071","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,11]]}}}