May 15, 2018
3 min read

Psychiatric disorders worsen bladder cancer survival

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An analysis of patients with muscle-invasive bladder cancer showed about half were diagnosed with a posttreatment psychiatric disorder.

The condition appeared associated with significantly worse survival, findings showed.

“Cancer diagnosis and treatment carry significant physical and emotional stress, which may affect survival outcomes,” Usama Jazzar, BS, teaching assistant in the department of urology at The University of Texas Medical Branch in Galveston, and colleagues wrote. “Patients with cancer are at increased risk for psychiatric disorders from the prediagnostic to the posttreatment period, because it has been demonstrated that approximately one-third of patients with cancer are at risk [for] developing a psychiatric disorder. Disorders like depression cause serious suffering and distress, reduced adherence to cancer care and increased risk [for] hospital readmission, which, in turn, may lead to worse survival.”

Jazzar and colleagues identified 3,709 patients in the SEER-Medicare database aged at least 66 years diagnosed with stage II through stage IV transitional cell or urothelial carcinoma from 2002 to 2011.

Of those treated for bladder cancer, 50.4% (n = 1,870) received a psychiatric disorder diagnosis after treatment. Psychiatric disorders included depression, substance use, mood disorders, anxiety, stress and delirium.

Among patients who underwent radical cystectomy (n = 1,861), the most common psychiatric disorders included mental and behavioral disorders caused by psychoactive substance use (19%), depressive episodes (13.5%), and symptoms involving cognitive functions and awareness (13.1%). Among patients who received radiotherapy and/or chemotherapy (n = 1,848), the most common disorders included mental and behavioral disorders caused by psychoactive substance use (13.7%), symptoms involving cognitive functions and awareness (13.5%), dizziness and giddiness (11.9%) and depression (9.2%).

Patients who underwent radical cystectomy demonstrated greater risk for posttreatment psychiatric illness than those who received radiotherapy and/or chemotherapy (53.6% vs. 47.2%; HR = 1.19; 95% CI, 1.07-1.31).

Median time to psychiatric diagnosis for patients who underwent radical cystectomy was 270 days.

Those who were younger, single and had advanced clinical disease demonstrated a greater risk for posttreatment psychiatric disorder diagnosis (all P < .05).

Patients diagnosed with posttreatment psychiatric disorder had significantly worse 1-year OS (HR = 2.8; 95% CI, 2.47-3.17) and 1-year cancer-specific survival (HR = 2.39; 95% CI, 2.05-2.78).

In an accompanying editorial, Andres F. Correas, MD, and Marc C. Smaldone, MD, MSHP, of Fox Chase Cancer Center, discussed the importance of the researchers’ focus on the 12 months after cancer treatment.


“Survivorship literature has deemed this transitional survivorship period as the most influential in determining the future psychological health of the cancer survivor,” they wrote. “The months after cancer treatment are when the patients and their caregiver(s) are most vulnerable to emotional distress as they are faced with the reality of their diagnosis and the sequelae of their treatment. The use of this specific period in their analysis may explain the high rates of psychiatric illness observed in the cohort.”

The lack of long-term follow-up represented a limitation of the study, according to Correa and Smaldone.

Substance use was the most common psychiatric diagnosis, affecting 32.5% of the study population. That is important to note in light of the opioid epidemic, according to Correa and Smaldone.

“Although it is impossible to discern the type of substance that was abused from Medicare claims, recent research has indicated that patients undergoing cancer surgery are at a greater risk [for] developing an opioid dependence compared with those undergoing benign surgery,” they wrote. “A recent study by Lee and colleagues revealed that patients undergoing curative-intent cancer surgery had a 10.4% risk [for] becoming chronic opioid users, which is significantly higher than that reported for noncancer surgeries (5% to 6%).”

The findings of this study underscore the need for clinicians to address posttreatment psychiatric disorders, according to the researchers.

“To optimize survival, nononcologic interventions like depression screening and survivorship clinics are critical. This information can be used to inform interventions to educate patients who have muscle-invasive bladder cancer regarding the impact of different treatments on mental health,” Jazzar and colleagues wrote. – by Cassie Homer

Disclosures: Jazzar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Correa and Smaldone report no relevant financial disclosures.