Patients with bladder cancer may experience mental health distress. Mental healthcare service (MHS) use can quantify the magnitude of the problem.
The Ontario Cancer Registry was used to identify all patients with bladder cancer treated with curative-intent cystectomy or radiotherapy in Ontario, Canada (2004-2013). Population-level databases were used to identify MHS use (visits to general practitioner, psychiatrist, emergency department or hospitalization). Generalized estimating equations were used to compare rates of MHS use. Baseline, peri-treatment and post-treatment MHS use were defined as visits from 2-years to 3-months before, 3-months before to 3-months after, and from 3-months after to 2-years after start of treatment, respectively.
From 2004-2013, 4296 patients underwent cystectomy (n = 3332) or curative-intent radiotherapy (n = 964). Compared to baseline, the rate of MHS use was higher in the peri-treatment (adjusted rate ratio [aRR] = 1.64; 95% confidence interval [CI] = 1.48-1.82) and post-treatment periods (aRR = 1.45; 95%CI =1.30-1.63). By 2-years post-treatment, 24.6% (95% CI = 23.4%-25.9%) of all patients had MHS use. Patients with baseline MHS use had substantially higher MHS use in the peri-treatment (aRR = 5.77; 95% CI = 4.86-6.86) and post-treatment periods (aRR = 4.58; 95% CI = 3.78-5.55). Female patients had higher use MHS use overall, but males had a higher incremental increase in the post-treatment period compared to baseline (two-sided interaction p-value=0.02). Male patients had a statistically significant increase in MHS use following surgery or radiotherapy whereas female patients only had an increase following surgery.
MHS use is common among patients undergoing treatment for bladder cancer, particularly in the peri-treatment period. Screening for mental health concerns in this population is warranted.
Journal of the National Cancer Institute. 2021 Mar 01 [Epub ahead of print]
Michael J Raphael, Rebecca Griffiths, Yingwei Peng, Sumit Gupta, D Robert Siemens, Claudio Soares, Christopher M Booth
Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Canada., Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada., Department of Mathematics and Statistics, Queen's University, Kingston, Canada., Department of Urology, Queen's University, Kingston, Canada.