Suicide in patients with genitourinary malignancies

New Mental Health Diagnosis as a Prognostic Factor for Muscle-Invasive Bladder Cancer

BACKGROUND

To examine differences in survival outcomes for muscle-invasive bladder cancer patients stratified by new mental health diagnosis.

METHODS

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer between 2008 and 2014. Our primary outcome was cancer-specific and overall hazards of mortality. As a secondary outcome, we reported predictors of developing a new mental health diagnosis after bladder cancer diagnosis. We used Cox proportional hazards models to determine the impact of palliative care and mental health diagnoses on survival outcomes after adjusting for grade, stage, comorbidity index, and baseline demographics.

RESULTS

Of the 3794 patients who met inclusion criteria, 1193 (31%) were diagnosed with a mental health illness after their bladder cancer diagnosis during the 6 years in the study period. The most common diagnoses were depression (13%), alcohol and drug abuse (12%), and anxiety (11%). Patients with a post-bladder cancer mental health diagnosis had a 57% higher hazard of overall mortality (HR 1.57, P = .048) and an 80% higher hazard of bladder cancer-specific mortality (HR 1.81, P = .037) 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.

Increased Risk of Recurrence of Non-Muscle Invasive Bladder Cancer Associated With Psychological Distress: A Prospective Cohort Study

OBJECTIVE

The primary aim was to evaluate the influence of depressive and anxiety symptoms on the 1-year recurrence rate of non-muscle invasive bladder cancer (NMIBC) patients. The secondary aim was to examine the risk factors leading to psychological distress.

METHODS

A total of 104 NMIBC patients were enrolled for interviews, and the Hospital Anxiety and Depression Scale (HADS) questionnaire survey was administered 1 month after their operation. Their cystoscopy results were followed up. The risk factors affecting their 1-year recurrence rate were evaluated through univariate analysis, Cox regression and Kaplan-Meier analysis. The risk factors causing depressive and anxiety symptoms were evaluated through univariate analysis and logistic regression.

RESULTS

In addition to American Urological Association risk stratification, depressive symptoms were another independent risk factor for recurrence in NMIBC patients (HR: 2.493, 95% CI: 1.048-5.930, p=0.039), and the increase in the recurrence rate was highly significant in intermediate-risk patients (HR: 8.496, 95% CI: 2.178-33.138, p=0.019). Anxiety symptoms were not an independent risk factor for recurrence (HR: 1.655, 95% CI: 0.714-3.837, p=0.240). We also observed that the burden of medical expenses of NMIBC on the family was an independent risk factor for depressive symptoms (p=0.029) and anxiety symptoms (p=0.048); chronic pain was an independent risk factor for anxiety symptoms (OR: 3.447, 95% CI: 1.182-10.052, p=0.023).

CONCLUSION

Depression symptoms are an independent risk factor for recurrence in NMIBC patients. Moreover, the burden of medical expenses on the family is an independent risk factor for depressive and anxiety symptoms in NMIBC patients. Additionally, chronic pain is a risk factor for anxiety symptoms in NMIBC patients. This study provided a theoretical foundation for clinical oncologists to pay more attention to the mental health of NMIBC patients.

Incidence and risk factors of suicide among patients diagnosed with bladder cancer: A systematic review and meta-analysis

BACKGROUND

Patients with bladder cancer have a high risk of suicide. This study aimed to assess how bladder cancer increases suicide risk and to identify the demographic and clinical factors associated with suicidal death among patients with bladder cancer.

METHODS

Literature search of MEDLINE, PsycINFO, Embase, Web of Sciences and Cochrane Library databases was conducted up to April 2020 to identify eligible studies related to the incidence and risk factors of suicide after bladder cancer diagnosis. Summary multivariate-adjusted risk estimates and their associated 95% confidence intervals (CIs) were calculated using inverse variance method with random or fixed-effect modeling.

RESULTS

Five retrospective cohorts comprising 563,680 patients with bladder cancer were included. Higher risk of suicide by 1.90-fold was observed among patients with bladder cancer (hazard ratio, HR = 1.90, 95% CI: 1.29-2.81; P = 0.001; I² = 81.2%), especially in those aged 70 years or older (HR = 1.36, 95% CI: 1.29-1.43; P < 0.001; I² = 0%), unmarried (HR = 1.72, 95% CI: 1.61-1.83; P < 0.001; I² = 0%), and those with regional bladder cancer (HR = 1.88, 95% CI: 1.10-3.21; P = 0.021; I² = 96.3%), compared with those without bladder cancer. Furthermore, gender and race were not associated with increased suicide risk among patients with bladder cancer.

CONCLUSIONS

Suicide risk is increased among patients with bladder cancer, particularly those aged 70 years or older, unmarried and those with regional bladder cancer. Hence, early psychological support must be provided during the follow-up period of these special populations with a high suicide risk.

Living with Bladder Cancer: Self-reported Changes in Patients' Functional and Overall Health Status Following Diagnosis

Background

Bladder cancer affects life quality, overall health, and mortality negatively. The effect of bladder cancer on activities of daily living (ADLs) is not well established.

Objective

To examine the effect of bladder cancer diagnosis on ADLs, in addition to physical, mental, and overall health measures.

Design setting and participants

Using data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) registry, responses regarding ADLs and overall health were evaluated in bladder cancer patients over time. The Short Form 12 health survey responses were analyzed to determine the change in physical and mental health scores following bladder cancer diagnosis.

Outcome measurements and statistical analysis

Changes in self-reported ability to perform ADLs and health outcomes following bladder cancer diagnosis were evaluated. Chi-square statistics were used to determine whether the baseline and follow-up surveys were statistically independent for each ADL. Composites scores for physical health (PCS12) and mental health (MCS12) were compared with two-sample t test.

Results and limitations

A total of 498 patients with surveys before and after bladder cancer diagnosis were identified. An increased percentage of patients reported difficulty in all ADL tasks following bladder cancer diagnosis; this increase was statistically significant for bathing (p = 0.02) and using the toilet (p = 0.03). These patients also reported a significant decline in overall health status (p = 0.0002). A significant reduction in the mean PCS12 and mean MCS12 composite scores was observed (p < 0.0001 and p = 0.0003, respectively).

Conclusions

Patients with bladder cancer report a significant decline in functional status and overall health, including both physical and mental well-being after diagnosis. Further study is needed for factors that may be most predictive of the decline in functional independence for this population.

Patient summary

There is a decreased ability to perform daily activities following bladder cancer diagnosis, and patients report a decrease in their physical and mental health. This information can help patients and their caregivers anticipate patient needs following bladder cancer diagnosis, in addition to helping manage their expectations when making decisions regarding treatment options.

Suicide in older adults: current perspectives

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.