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

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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

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Preexisting Condition Coverage
Urinary Bladder Neoplasms
Survival
Mental Disorders
Cystectomy
Muscles
Therapeutics
Guidelines
Confidence Intervals
Depression
Odds Ratio
Neoplasms
Medicare
Bipolar Disorder
Psychotic Disorders
Schizophrenia
Mental Health
Epidemiology
Anxiety
Logistic Models

Keywords

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

Cite this

@article{851bf292ef214f6aae3b5f2e53a0c0a4,
title = "Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness",
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.",
keywords = "Bladder cancer, Health disparities, Health outcomes, Mental disorders",
author = "Sathianathen, {Niranjan J} and Yunhua Fan and Jarosek, {Stephanie L} and Isha Konety and Weight, {Christopher J} and Sophia Vinogradov and Konety, {Badrinath R}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.euf.2019.02.007",
language = "English (US)",
journal = "European Urology Focus",
issn = "2405-4569",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness

AU - Sathianathen, Niranjan J

AU - Fan, Yunhua

AU - Jarosek, Stephanie L

AU - Konety, Isha

AU - Weight, Christopher J

AU - Vinogradov, Sophia

AU - Konety, Badrinath R

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Bladder cancer

KW - Health disparities

KW - Health outcomes

KW - Mental disorders

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U2 - 10.1016/j.euf.2019.02.007

DO - 10.1016/j.euf.2019.02.007

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JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

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