Characterizing psychological resources and resilience in patients with bladder cancer: Associations with frailty and quality of life.
Authors: Erin Petersen, Sarah K Holt, Anne Browning, Samia Jannat, Dana Cavanaugh, Jonathan L. Wright, John L. Gore, George R. Schade, Sarah P. Psutka
Journal: Journal of Clinical Oncology (2024)

585 Background: Bladder cancer (BC) profoundly affects patients’ mental and physical well-being, with significant impacts to quality of life (QOL), mental health, and ability to perform activities of daily living. Understanding factors that influence patients’ responses to BC is crucial to tailored care. One such factor that has yet to be studied in BC patients is resilience, or the ability to maintain or restore baseline function following a stressor. Our objective was to demonstrate the feasibility of prospectively characterizing baseline resilience and frailty in patients with BC. We hypothesized that resilience and psychological resources (PsyResources) would be positively associated with improved QOL and inversely associated with frailty. Methods: With IRB approval, we enrolled patients with BC (N=67) from a urology clinic (6/20-7/2021). Patients completed a comprehensive geriatric assessment incorporating validated assessments of frailty and PsyResources: University of Washington Resilience Survey (UWR), Psychological Capital (PsyCap), Brief Inventory of Thriving (BIT), and Self-Compassion Survey (SCS) which measure resilience, psychological capital, mental health, and self-compassion, respectively. Validated QOL surveys were completed at 2 weeks, 3 and 6 months post-treatment. Correlation matrices evaluated PsyResources’ links with baseline frailty and Spearman’s correlation coefficient (ρ) was reported. Associations between PsyResources, anxiety and depression, and QOL were evaluated with linear regression. Results: The median age of the cohort was 71 (83.6% male) and 77.6% had muscle-invasive BC (cN+:20.9%, M1: 7.6%). PsyResource assessment completion rates ranged 96-100% and had strong inter-assessment associations (ρ=0.52-0.81, p&lt; 0.0001 for all). Baseline PsyResources were strongly inversely correlated with the geriatric depression scale, (ρ=-0.50-0.65, p&lt;0.0001). Negative correlations were found between functional frailty and SCS (ρ=-0.37, p=0.006). A higher baseline of each PsyResource was associated with improved global symptoms, emotional function, and body image (BIT and SCS) (p&lt;0.05) and decreased anxiety and depression over time (B:-0.167 to -2.46; p&lt;0.02). Conclusions: We present the first prospective characterization of baseline PsyResources in patients with BC, revealing positive correlations with mental health and inverse correlations with functional frailty. Interestingly, PsyResources were associated with improved QOL outcomes over time. Ongoing work is exploring the relationship between resilience and different domains of frailty and the potential role of functional recovery and decline following BC treatment. Future work will also evaluate associations with survival outcomes and the ability to modify resilience to facilitate recovery of functional status and quality of life after treatment.