Presentation Authors: Niranjan Sathianathen*, Yunhua Fan, Stephanie Jarosek, Isha Konety, Christopher Weight, Sophia Vinogradov, Badrinath Konety, Minneapolis, MN
Introduction: There is an abundance of evidence demonstrating that patients with severe mental illness experience inferior care and excess mortality in both the general medical and oncological field but this is yet to be assessed in the bladder cancer setting. Therefore, we aim to characterize the patterns of care and survival of elderly patients with a pre-existing mental illness diagnosed with bladder cancer.
Methods: We conducted a retrospective analysis of elderly patients (>=68 years old) enrolled in Surveillance, Epidemiology, and End Results (SEER)-Medicare and diagnosed with bladder cancer from 2004-2011. International Classification of Diseases, Clinical Modification codes were used to identify patients with severe mental illness (consisting of bipolar disorder, schizophrenia and other psychotic disorders); anxiety and/or depression. We compared the stage of presentation, receipt of guideline concordant therapies (radical cystectomy for muscle-invasive disease) and survival between patients with a pre-existing mental disorder and those without.
Results: A total of 66,476 cases were included for analysis of which, 6.7% (n=4,468) had a pre-existing mental health disorder at the time of cancer diagnosis. Patients with severe mental illness were significantly more likely to present with muscle-invasive disease compared to those with no psychiatric diagnosis (23.0% vs 19.4%, p < 0.01) and also had a higher likelihood of presenting with metastases but this did not achieve statistical significance. In patients with muscle-invasive disease, those with severe mental illness [OR 0.62, 95%CI 0.39-0.99] and depression only [OR 0.76, 95%CI 0.60-0.97] were significant less likely to undergo radical cystectomy. Patient in this subgroup who underwent radical cystectomy had significantly superior overall [HR 0.54, 95%CI 0.43-0.67] (Figure 1) and disease-specific survival [HR 0.64, 95%CI 0.48-0.84].
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. Patients with a mental illness were also more likely to present with more advanced disease and have a worse prognosis.