(UroToday.com) The 2024 American Urological Association (AUA) annual meeting held in San Antonio, TX between May 3 and May 6, 2024, was host to the Bladder Cancer: Epidemiology & Evaluation Moderated Poster Session. Dr. Matthew DeSanto presented the results of a large retrospective cohort study evaluating the effects of neoadjuvant chemotherapy (NAC) on rates of depression in muscle-invasive bladder cancer (MIBC) patients.
The investigators employed ICD-10 codes associated with bladder cancer and depression to identify their target population, which comprised patients with stage T2 bladder cancer who underwent radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) within 90 days of surgery. Utilizing a propensity score matching model, they adjusted for various clinical and demographic factors.
The study's primary endpoint was the occurrence of a depressive episode within 3 months of NAC, while secondary outcomes encompassed hospitalization rates, overall mortality, and suicide attempts within the same timeframe post-surgery. Patients’ characteristics are shown in the table below:
A total of 4,630 patients were included for analysis after propensity score matching, with 2,315 individuals in each group: one exposed to NAC and the other not. Among those who received NAC, 10.5% experienced a depressive episode within 3 months of radical cystectomy (RC). In contrast, 6.2% of patients in the non-NAC group were diagnosed with depressive episodes, demonstrating a statistically significant difference (95% CI [0.027; 0.059]; p<0.001). Dr. DeSanto reported an odds ratio of 1.768 (95% CI [1.426, 2.192]) for depression presentation in the NAC-treated cohort compared to those not exposed to NAC.
The investigators also evaluated mortality rates and found no significant differences between the two cohorts (p=0.844). Additionally, there was no notable variance in the rate of inpatient hospitalization between patients who underwent NAC and those who did not (p=0.191). However, they observed a statistically significant increase in suicide attempts in the NAC group (p=0.002).
Dr. DeSanto concluded his presentation by highlighting that their retrospective cohort study revealed a correlation between NAC followed by RC with an elevated incidence of depression and suicidal attempts within 3 months of surgery. They hypothesize that the higher incidence of depression is related to the morbidity associated with chemotherapy and the possible anxiety related to the surgical delay.
Consequently, he emphasized the importance of providing these patients with specialized care and attention, including mental health counseling and active screening for depression symptoms.
Presented by: Matthew DeSanto, MD, PhD, Urologist, Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV
Written by: Julian Chavarriaga, MD - Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @chavarriagaj on Twitter during the 2024 American Urological Association (AUA) annual meeting held in San Antonio, TX between May 3rd and May 6th, 2024