A bladder cancer patient’s self-reported mental health prior to radical cystectomy might be a better harbinger of postoperative complications than physical health, according to a new study.

“Prior studies have suggested that poor baseline mental health can lead to more significant postoperative complications possibly due to impaired immune response associated with higher levels of stress,” lead researchers Scott M. Gilbert, MD, MS, of the H. Lee Moffitt Cancer Center in Tampa, Fla., explained in a press release. “This may delay both wound healing and the ability to fight infection in the postoperative state, for example.”

Dr. Gilbert and colleagues examined responses from 274 bladder cancer patients treated at their center who completed the Medical Outcomes Study Short Form (SF-12), a 12-question survey that measures physical and mental components of health, in the months before surgery.

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Results published in The Journal of Urology showed that 16.8% of patients experienced a high-grade complication within 30 days of radical cystectomy with urinary diversion, as identified by the Clavien-Dindo classification.  The median mental composite score on the SF-12 was significantly lower in patients with a high-grade complication (44.8 vs. 49.8), whereas the physical composite score was no different (39.2 vs. 43.8).

To determine whether components of the SP-12 were clinically relevant predictors of complications, the investigators employed an expert model of known factors associated with high-grade complications (e.g., age, body mass index, Charlson comorbidity index, preoperative albumin, and clinical stage). The model itself did not significantly predict complications. When the mental health component of the SP-12 was added, however, it became significant. Having higher mental health scores was also associated with a decreased incidence of high-grade complications.

Validated questionnaires such as the SP-12 “may provide additional information useful in predicting short-term postoperative outcomes,” the researchers concluded. They highlighted the potential of other specific mental health measures such as the Beck Depression Inventory and Burns Anxiety Inventory for future, prospective studies.

Among the limitations, the investigators stated that they could not account for life stressors beyond surgery, such as job loss or financial difficulties.


  1. Sharma P, Henriksen CH, Zargar-Shoshtari K, et al. Preoperative Patient Reported Mental Health  is Associated with High Grade Complications After Radical Cystectomy. The Journal of Urology. doi: 10.1016/j.juro.2015.07.095.