Presentation Authors: Omar Ayyash*, Jonathan Yabes, Lee Hugar, Avinash Maganty, Pittsburgh, PA, Stephen Williams, Galveston, TX, Benjamin Davies, Bruce Jacobs, Pittsburgh, PA
Introduction: Bladder cancer is a devastating illness with significant morbidity, even after treatment, that can impact quality of life and mental health. The prevalence of new psychiatric diagnoses in patients with advanced bladder cancer is unknown. We examined differences in survival outcomes for muscle invasive bladder cancer patients stratified by new psychiatric diagnosis.
Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with muscle invasive bladder cancer between 2008 and 2013. Our primary outcome was to determine the prevalence of new psychiatric diagnoses. As a secondary outcome we looked at palliative care utilization and its influence over survival in this cohort. We used Cox proportional hazards models to determine the impact of palliative care and psychiatric diagnoses on survival outcomes after adjusting for grade, stage, comorbidity index, and baseline demographics.
Results: Of the 4,247 patients who met inclusion criteria, 1,510 (35%) were diagnosed with a psychiatric illness after their bladder cancer diagnosis. The most common diagnoses were depression (13%), alcohol and drug abuse (12%), and anxiety (11%). Patients with a post-bladder cancer psychiatric diagnosis had 60% higher odds of mortality (HR 1.6, p < 0.001). Among those with a post-bladder cancer psychiatric diagnosis, palliative care utilization was not associated with improved survival.
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.
Source of Funding: Bruce L. Jacobs is supported in part by the American Urological Association Data Grant and the University of Pittsburgh Physicians Foundation. The views expressed in this abstract do not reflect the views of the Federal government or Ben Davies.