To address this gap, we utilized the National Institutes of Health All of Us Research Program, a database of United States individuals that intentionally oversamples populations historically underrepresented in biomedical research. A key advantage of the All of Us program is the validated survey infrastructure, which includes multiple measures of mental health, social connectedness, and perceived respect within healthcare encounters. Thus, we aimed to investigate gender differences in self-reported psychosocial metrics among bladder cancer survivors while adjusting for clinical and sociodemographic factors like education and marital status.
Our cohort included 319 women and 766 men with bladder cancer. When adjusted for demographics and comorbidities, self-reported general mental and social health scores were similar across gender groups. However, women exhibited threefold higher odds of documented post-diagnosis depressive disorder. Women also more frequently reported lacking companionship, experiencing stress or nervousness, and struggling to cope. Self-reported respect or courtesy in social and healthcare settings did not differ by gender.
Although women reported greater social isolation and stress, overall social and mental health scores were not significant after adjusting for sociodemographic factors, suggesting that survivors’ experiences are shaped by a constellation of factors beyond gender. We found no gender disparity in reported interactions with healthcare providers—a reassuring result given the longstanding history of delayed urology referrals and inadequate sexual health counseling in women. Despite limitations, including the cross-sectional design and limited detail on disease stage, our study underscores the need for targeted mental health screening and sustained psychosocial support through survivorship.
Key Takeaways
- Women may have a disproportionate psychosocial burden. Among 1,085 bladder cancer survivors (319 women, 766 men), post-diagnosis depression was documented in 25% of women and 10% of men, compared with 7% and 2% prediagnosis, respectively.
- General social, mental health scores were similar among men and women after adjusting for clinical and social factors. However, companionship, feeling isolated, experiencing stress/nervousness, and being unable to cope with day-to-day demands were common and gendered.
- Relationships with clinicians appear more equitable than expected. Perceived quality of provider interactions, courtesy, and respect did not differ by gender in this cohort.
- Mental health should be addressed in clinical practice for all individuals receiving survivorship care. Asking about mood, loneliness, and coping should be routine and trigger a timely referral to support resources when concerns are identified.
- Aidan S. Weitzner, Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Nirmish Singla, MD, MSCS, FACS, Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA