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 journalArticle

4 Scopus citations

Abstract

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)
JournalEuropean Urology Focus
DOIs
StatePublished - Jan 1 2019

Keywords

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

PubMed: MeSH publication types

  • Journal Article

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