Highlights
- •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.
Abstract
Background
To examine differences in survival outcomes for muscle-invasive bladder cancer patients
stratified by new mental health diagnosis.
Methods
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.
Results
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)
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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: 343-350https://doi.org/10.1016/S2215-0366(14)70313-X
- Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a national matched cohort study in Sweden.JAMA Oncology. 2016; 2: 1188-1196https://doi.org/10.1001/jamaoncol.2016.0483
- Economics aspects of bladder cancer: what are the benefits and costs?.World J Urol. 2009; 27: 295-300https://doi.org/10.1007/s00345-009-0395-z
- Suicide in patients with genitourinary malignancies.Eur J Cancer Care (Engl). 2017; 26 ([Epub 2017 Jan 30])https://doi.org/10.1111/ecc.12635
- Mental health morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.J Clin Oncol. 2002; 20: 1907-1917https://doi.org/10.1200/JCO.2002.07.101
- Depression and degree of acceptance of adjuvant cytotoxic drugs.Lancet. 2000; 356: 1326-1327https://doi.org/10.1016/S0140-6736(00)02821-X
- Perioperative oral nutrition supplementation reduces prevalence of sarcopenia following radical cystectomy: results of a prospective randomized controlled trial.J Urol. 2019; 201: 470-477https://doi.org/10.1016/j.juro.2018.10.010
- Frailty as a predictor of complications after radical cystectomy: a prospective study of various preoperative assessments.Urol Oncol. 2019; 37: 40-47https://doi.org/10.1016/j.urolonc.2018.10.002
- Mental health implications in bladder cancer patients: a review.Urologic Oncol. 2019; 37: 97-107https://doi.org/10.1016/j.urolonc.2018.12.006
- Impact of mental health illness on decreased survival in elderly patients with bladder cancer in the United States.Cancer. 2018; 124: 3127-3135https://doi.org/10.1002/cncr.31404
- Risk for recurrence in depression.Clin Psychol Rev. 2007; 27: 959-985https://doi.org/10.1016/j.cpr.2007.02.005
- Development of a comorbidity index using physician claims data.J Clin Epidemiol. 2000; 53: 1258-1267https://doi.org/10.1016/s0895-4356(00)00256-0
- Palliative care use amongst patients with bladder cancer.BJU Int. 2019; 123: 968-975https://doi.org/10.1111/bju.14708
- Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.Eur Urol. 2009; 55: 164-176https://doi.org/10.1016/j.eururo.2008.07.031
- The DSM-5 classification of mood disorders: some fallacies and fault lines.Acta Psychiatr Scand. 2014; 129: 404-409https://doi.org/10.1111/acps.12253
- DSM-5 and mental disorders in older individuals: an overview.Harv Rev Psychiatry. 2015; 23: 320-328https://doi.org/10.1097/HRP.0000000000000090
- The psychological impact of mammographic screening: a systematic review.Psychooncology. 2005; 14: 917-938https://doi.org/10.1002/pon.904
- The measurement of psychological distress in men being investigated for the presence of prostate cancer.Prostate Cancer Prostatic Dis. 2008; 11: 384-389https://doi.org/10.1038/pcan.2008.21
- Psychological distress following fecal occult blood test in colorectal cancer screening: a population-based study.Scand J Gastroenterol. 2010; 45: 1211-1216https://doi.org/10.3109/00365521.2010.485355
- Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a nationwide matched cohort study in Sweden.JAMA Oncol. 2016; 2: 1188-1196https://doi.org/10.1001/jamaoncol.2016.0483
- Psychological stress and suicide in bladder cancer patients.Bladder Cancer. 2018; 4: 245-246https://doi.org/10.3233/BLC-189031
- 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: 1440-1445https://doi.org/10.1200/JCO.2008.20.5526
- Suicide and cardiovascular death after a cancer diagnosis.N Engl J Med. 2012; 366: 1310-1318https://doi.org/10.1056/NEJMoa1110307
- Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.Lancet. 2007; 370: 841-850https://doi.org/10.1016/S0140-6736(07)61414-7
- Factors associated with suicide in patients with genitourinary malignancies.Cancer. 2015; 121: 1864-1872https://doi.org/10.1002/cncr.29274
- Assessment of perioperative psychological distress in patients undergoing radical cystectomy for bladder cancer.J Urol. 2004; 172: 1814-1817https://doi.org/10.1097/01.ju.0000141245.08456.1a
- Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.Urol Oncol. 2015; 33: 267https://doi.org/10.1016/j.urolonc.2015.02.012
- https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf. Accessed: March 11, 2019.
- 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: 1605-1619https://doi.org/10.1200/JCO.2013.52.4611
Article info
Publication history
Published online: November 01, 2022
Accepted:
October 24,
2022
Received in revised form:
October 11,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
