New Mental Health Diagnosis as a Prognostic Factor for Muscle-Invasive Bladder Cancer

Published:November 01, 2022DOI:


      • A diagnosis of bladder cancer increases the hazard of being diagnosed with a new mental health disorder.
      • Patients who are diagnosed with a new mental health disorder after their cancer diagnosis have worse overall survival.
      • The most common mental health disorders among those with a new bladder cancer diagnosis are depression, substance abuse, and anxiety.



      To examine differences in survival outcomes for muscle-invasive bladder cancer patients stratified by new mental health diagnosis.


      Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer between 2008 and 2014. Our primary outcome was cancer-specific and overall hazards of mortality. As a secondary outcome, we reported predictors of developing a new mental health diagnosis after bladder cancer diagnosis. We used Cox proportional hazards models to determine the impact of palliative care and mental health diagnoses on survival outcomes after adjusting for grade, stage, comorbidity index, and baseline demographics.


      Of the 3794 patients who met inclusion criteria, 1193 (31%) were diagnosed with a mental health illness after their bladder cancer diagnosis during the 6 years in the study period. The most common diagnoses were depression (13%), alcohol and drug abuse (12%), and anxiety (11%). Patients with a post-bladder cancer mental health diagnosis had a 57% higher hazard of overall mortality (HR 1.57, P = .048) and an 80% higher hazard of bladder cancer-specific mortality (HR 1.81, P = .037)


      New mental health diagnoses are associated with worse survival in patients with muscle invasive bladder cancer. This suggests that a multimodal approach to bladder cancer treatment should include addressing the non-oncologic needs of the patient to optimize survival outcomes.


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        • Walker J
        • Hansen CH
        • Martin P
        • et al.
        Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data.
        Lancet Psychiatry. 2014; 1: 343-350
        • Lu D
        • Andersson TML
        • Fall K
        • et al.
        Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a national matched cohort study in Sweden.
        JAMA Oncology. 2016; 2: 1188-1196
        • Sievert KD
        • Amend B
        • Nagele U
        • et al.
        Economics aspects of bladder cancer: what are the benefits and costs?.
        World J Urol. 2009; 27: 295-300
        • de Lima MM
        • Tobias-Machado M.
        Suicide in patients with genitourinary malignancies.
        Eur J Cancer Care (Engl). 2017; 26 ([Epub 2017 Jan 30])
        • Prieto JM
        • Blanch J
        • Atala J
        • et al.
        Mental health morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.
        J Clin Oncol. 2002; 20: 1907-1917
        • Colleoni M
        • Mandala M
        • Peruzzotti G
        • Robertson C
        • Bredart A
        • Goldhirsch A.
        Depression and degree of acceptance of adjuvant cytotoxic drugs.
        Lancet. 2000; 356: 1326-1327
        • Ritch CR
        • Cookson MS
        • Clark PE
        • et al.
        Perioperative oral nutrition supplementation reduces prevalence of sarcopenia following radical cystectomy: results of a prospective randomized controlled trial.
        J Urol. 2019; 201: 470-477
        • Burg ML
        • Clifford TG
        • Bazargani ST
        • et al.
        Frailty as a predictor of complications after radical cystectomy: a prospective study of various preoperative assessments.
        Urol Oncol. 2019; 37: 40-47
        • Pham H
        • Torres H
        • Sharma P.
        Mental health implications in bladder cancer patients: a review.
        Urologic Oncol. 2019; 37: 97-107
        • Jazzar U
        • Yong S
        • Klaasen Z
        • et al.
        Impact of mental health illness on decreased survival in elderly patients with bladder cancer in the United States.
        Cancer. 2018; 124: 3127-3135
        • Burcusa SL
        • Iacono WG.
        Risk for recurrence in depression.
        Clin Psychol Rev. 2007; 27: 959-985
        • Klabunde CN
        • Potosky AL
        • Legler JM
        • Warren JL.
        Development of a comorbidity index using physician claims data.
        J Clin Epidemiol. 2000; 53: 1258-1267
        • Hugar LA
        • Lopa SH
        • Yabes JG
        • et al.
        Palliative care use amongst patients with bladder cancer.
        BJU Int. 2019; 123: 968-975
        • Shabsigh A
        • Korets R
        • Vora KC
        • et al.
        Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.
        Eur Urol. 2009; 55: 164-176
        • Parker G.
        The DSM-5 classification of mood disorders: some fallacies and fault lines.
        Acta Psychiatr Scand. 2014; 129: 404-409
        • Sachdev PS
        • Mohan A
        • Taylor L
        • Jeste DV.
        DSM-5 and mental disorders in older individuals: an overview.
        Harv Rev Psychiatry. 2015; 23: 320-328
        • Brett J
        • Bankhead C
        • Henderson B
        • Watson E
        • Austoker J.
        The psychological impact of mammographic screening: a systematic review.
        Psychooncology. 2005; 14: 917-938
        • Awsare NS
        • Green JS
        • Aldwinckle B
        • Hanbury DC
        • Boustead GB
        • McNicholas TA.
        The measurement of psychological distress in men being investigated for the presence of prostate cancer.
        Prostate Cancer Prostatic Dis. 2008; 11: 384-389
        • Brasso K
        • Ladelund S
        • Frederiksen BL
        • Jørgensen T.
        Psychological distress following fecal occult blood test in colorectal cancer screening: a population-based study.
        Scand J Gastroenterol. 2010; 45: 1211-1216
        • Lu D
        • Andersson TM
        • Fall K
        • et al.
        Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a nationwide matched cohort study in Sweden.
        JAMA Oncol. 2016; 2: 1188-1196
        • Messing EM.
        Psychological stress and suicide in bladder cancer patients.
        Bladder Cancer. 2018; 4: 245-246
        • Dalton SO
        • Laursen TM
        • Ross L
        • Mortensen PB
        • Johansen C.
        Risk for hospitalization with depression after a cancer diagnosis: a nationwide, population-based study of cancer patients in Denmark from 1973 to 2003.
        J Clin Oncol. 2009; 27: 1440-1445
        • Fang F
        • Fall K
        • Mittleman MA
        • et al.
        Suicide and cardiovascular death after a cancer diagnosis.
        N Engl J Med. 2012; 366: 1310-1318
        • Wang PS
        • Aguilar-Gaxiola S
        • Alonso J
        • et al.
        Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.
        Lancet. 2007; 370: 841-850
        • Klaassen Z
        • Jen RP
        • DiBianco JM
        • et al.
        Factors associated with suicide in patients with genitourinary malignancies.
        Cancer. 2015; 121: 1864-1872
        • Palapattu GS
        • Haisfield-Wolfe ME
        • Walker JM
        • et al.
        Assessment of perioperative psychological distress in patients undergoing radical cystectomy for bladder cancer.
        J Urol. 2004; 172: 1814-1817
        • Rabow MW
        • Benner C
        • Shepard N
        • Meng MV.
        Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.
        Urol Oncol. 2015; 33: 267
        • Andersen BL
        • DeRubeis RJ
        • Berman BS
        • et al.
        Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation.
        J Clin Oncol. 2014; 32: 1605-1619