Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness

Niranjan J. Sathianathen, Yunhua Fan, Stephanie L. Jarosek, Isha Konety, Christopher J. Weight, Sophia Vinogradov, Badrinath R. Konety

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


BACKGROUND: Pre-existing mental illness is known to adversely impact cancer care and outcomes, but this is yet to be assessed in the bladder cancer setting.

OBJECTIVE: To characterize the patterns of care and survival of elderly patients with a pre-existing mental illness diagnosed with bladder cancer.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective analysis of patients enrolled in Surveillance, Epidemiology, and End Results (SEER)-Medicare. A population-based sample was considered. Elderly patients (≥68 yr old) with localized bladder cancer from 2004 to 2011 were stratified by the presence of a pre-existing mental illness at the time of cancer diagnosis: severe mental illness (consisting of bipolar disorder, schizophrenia, and other psychotic disorders), anxiety, and/or depression.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed multivariable logistic regression analyses to compare the stage of presentation and receipt of guideline-concordant therapies (radical cystectomy for muscle-invasive disease). Survival between patients with a pre-existing mental disorder and those without were compared using Kaplan-Meier analyses with log-rank tests.

RESULTS AND LIMITATIONS: Of 66 476 cases included for analysis, 6.7% (n=4468) had a pre-existing mental health disorder at the time of cancer diagnosis. These patients were significantly more likely to present with muscle-invasive disease than those with no psychiatric diagnosis (23.0% vs 19.4%, p-<0.01). In patients with muscle-invasive disease, those with severe mental illness (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.37-0.81) and depression only (OR 0.71, 95% CI 0.58-0.88) were significantly less likely to undergo radical cystectomy or trimodality therapy. Patients in this subgroup who underwent radical cystectomy had significantly superior overall (hazard ratio [HR] 0.54, 95% CI 0.43-0.67) and disease-specific survival (HR 0.76, 95% CI 0.58-0.99) compared with those who did not receive curative treatment.

CONCLUSIONS: Elderly patients with muscle-invasive bladder cancer and a pre-existing mental disorder were less likely to receive guideline-concordant management, which led to poor overall and disease-specific survival.

PATIENT SUMMARY: Patients with severe mental illness and depression were only significantly less likely to undergo radical cystectomy for muscle-invasive disease, that is, to receive guideline-concordant treatment. Overall survival and disease-specific survival were inferior in patients with a pre-existing mental disorder, and were especially low in those who did not receive guideline-concordant care.

Original languageEnglish (US)
Pages (from-to)1180-1187
Number of pages8
JournalEuropean Urology Focus
Issue number6
StatePublished - Oct 15 2020

Bibliographical note

Funding Information:
Bladder cancer patients with a pre-existing mental illness experience disparities in care that lead to lower OS and DSS. We observed underutilization of RC and TMT in MIBC patients with a mental illness, which results in poor survival outcomes. This highlights the importance of establishing support systems in this vulnerable group to ensure that they are cared for in a timely manner and in accordance with clinical practice guidelines to address the observed disparity. This meeting is to be presented at the American Urology Association Annual Meeting, 2019, Chicago, USA. Author contributions: Niranjan J. Sathianathen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Sathianathen, B.R. Konety. Acquisition of data : Sathianathen, I. Konety, Fan, Jarosek. Analysis and interpretation of data : Sathianathen, Fan, Jarosek, Weight, Vinogradov, B.R. Konety. Drafting of the manuscript : Sathianathen, I. Konety, Fan. Critical revision of the manuscript for important intellectual content : Jarosek, Weight, Vinogradov, B.R. Konety. Statistical analysis : Fan, Jarosek. Obtaining funding : None. Administrative, technical, or material support : Jarosek. Supervision : B.R. Konety, Weight, Vinogradov. Other : None. Financial disclosures: Niranjan J. Sathianathen certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: Niranjan J. Sathianathen has received support from the Cloverfields Foundation and the Institute for Prostate and Urologic Cancers (University of Minnesota). Appendix A

Publisher Copyright:
© 2019 European Association of Urology


  • Bladder cancer
  • Health disparities
  • Health outcomes
  • Mental disorders

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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