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Mental health resource use among patients undergoing curative intent treatment for bladder cancer

Raphael MJ, Griffiths R, Peng Y, Gupta S, Siemens DR, Soares C, Booth CM. J Natl Cancer Inst. 2021; 113(9):1238-45. Epub 2021 Mar 1. DOI:

Background — Patients with bladder cancer may experience mental health distress. Mental healthcare service (MHS) use can quantify the magnitude of the problem.

Methods — 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.

Results — 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.

Conclusion — 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.