SUO 2017: Impact of Post-Treatment Psychiatric Illness on Survival Outcomes Following Muscle-Invasive Bladder Cancer Patients

Washington, DC ( With better understand of disease processes and treatments, we have also begun to understand the implications and burden of survival on cancer survivors. In this study, the authors continue the work of understanding the impact of post-treatment psychiatric illness on survival outcomes in patients with muscle-invasive bladder cancer, a disease process in which the radical treatment carries heavy physical and mental burden.

Utilizing the SEER-Medicare dataset, which allows for increased granularity compared to the SEER data alone, but is limited to patients 65 years and older, the authors identified a total of 3,709 patients diagnosed with clinical stage T2-T4a bladder cancer from January 1, 2001 to December 31, 2011. In this group, they determined the incidence of psychiatric diagnosis for each treatment, used multivariable analysis to determine predictors associated with psychiatric diagnoses, and determined the impact of post-treatment psychiatric diagnosis on survival outcomes. 

Of the 3,709 patients, 1,870 (50.4%) were diagnosed with post-treatment psychiatric disorders, which is itself surprising – 53.6% in patients undergoing RC and 47.2% in those undergoing radiotherapy or chemotherapy. The most common diagnoses were mental and behavioral disorder due to psychoactive substance use and depressive disorders, respectively. Patients who underwent radical cystectomy (RC) were found to be at a significantly greater risk of having a post-treatment psychiatric illness in comparison to patients who underwent radiotherapy and/or chemotherapy (RTX and/or CTX) (HR 1.19, 95% CI = 1.08 - 1.32, P < 0.001). In adjusted analyses, patients with a post-treatment psychiatric diagnosis were found to have significantly worse overall and cancer-specific survival than patients without a post-treatment psychiatric diagnosis across all treatments. 

The important take-home message is that half (50%!) of muscle-invasive bladder cancer patients who underwent treatment were diagnosed with a psychiatric disorder which resulted in worse survival outcomes as compared to patients without a post-treatment psychiatric diagnosis. This highlights the need to address the non-oncologic needs of patients (i.e. depression screening, treatment, and survivorship clinics).  

Limitations / Discussion Points:

  1. It was unclear in the abstract how patients with prior psychiatric diagnoses were managed? Were they excluded from the analysis? Were they more likely to receive one treatment than another?
  1. What was the other-cause mortality for patients with psychiatric illness? While prior studies by this group1,2 have indicated an suicide rate specific for patients with bladder cancer, it would be nice to see this delineated in the abstract.

  1. The Impact of Radical Cystectomy and Urinary Diversion on Suicidal Death in Patients With Bladder Cancer. Klaassen Z, DiBianco JM, Jen RP, Harper B, Yaguchi G, Reinstatler L, Woodard C, Moses KA, Terris MK, Madi R. J Wound Ostomy Continence Nurs. 2016 Mar-Apr;43(2):152-7.
  1. Factors associated with suicide in patients with genitourinary malignancies. Klaassen Z, Jen RP, DiBianco JM, Reinstatler L, Li Q, Madi R, Lewis RW, Smith AM, Neal DE Jr, Moses KA, Terris MK. Cancer. 2015 Jun 1;121(11):1864-72. doi: 10.1002/cncr.29274. Epub 2015 Feb 1

Presented by: Tamer Dafashy

Co-Authors: Usama Jazzar, Christopher Kosarek, Shan Yong, Zachary Klaassen, Jinhai Huo, Byron Hughes, Edgar Esparza, Hemalkumar Mehta, Yong-Fang Kuo, Simon Kim, Douglas Tyler, Stephen Freedland, Ashish Kamat, Martha Terris, Dwight Wolf, Stephen Williams

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC