Effects of Neoadjuvant Chemotherapy on Rates of Depression in Muscle Invasive Bladder Cancer

다국어 초록 (Multilingual Abstract)

Purpose: The objective of this large retrospective cohort study is to better understand the relationship of bladder cancer and depression incidence, specifically relating to the incorporation of neoadjuvant chemotherapy (NCT) in treatment plans.
Materials and Methods: This is a large retrospective cohort study utilizing a formulated dataset from the TriNetX Research Network Database. ICD-10 (International Statistical Classification of Diseases, 10th revision) codes related to bladder cancer and depression diagnoses and treatments were implemented to identify patients of interest. Propensity score matching was implemented for various demographic factors and comorbidities. The patient population was limited to stage T2 bladder cancer, and NCT was defined as receival within 90 days prior to cystectomy (CYS). The primary outcome was denoted as depressive episode diagnosis within 3 months of CYS. Secondary outcomes of hospitalizations, mortality, and suicide attempts within 3 months of CYS were analyzed.
Results: In total, 4,630 patients were included after propensity score matching, yielding 2,315 patients per group. All patients had T2 disease and underwent CYS. In the NCT cohort, 243 patients (10.5%) acquired a diagnosis of depression within 3 months from CYS compared to 144 patients (6.2%) who received no NCT (95% confidence interval [CI], 0.027– 0.059; p<0.001). Odds ratio was 1.768 (95% CI, 1.426–2.192) when comparing cohorts with and without NCT. There was no statistical difference in mortality (95% CI, -0.012 to 0.014; p=0.844) or inpatient hospitalizations (95% CI, -0.046 to 0.009; p=0.191) within 3 months. There was a statistically significant increase in suicide attempts in the NCT group within 3 months (95% CI, 0.002–0.007; p=0.002).
Conclusions: Bladder cancer can induce significant patient morbidity with ensuing depression. Our retrospective cohort study demonstrates NCT correlates to increased incidence of depression as well as suicidal attempts. Assiduous attention needs to be directed towards mental health counseling and treatment for oncologic patients.

참고문헌 (Reference)

• 1 Smith CB, "Using the new ASCO clinical practice guideline for palliative care concurrent with oncology care using the TEAM approach" 37 : 714-723, 2017
• 2 박보람 ; 윤소영 ; 이기경 ; 이수연 ; 이정선 ; 정석훈, "The prevalence of depression among patients with the top ten most common cancers in South Korea" 14 : 618-625, 2017
• 3 Vartolomei L, "Systematic review : depression and anxiety prevalence in bladder cancer patients" 4 : 319-326, 2018
• 4 Yousaf U, "Suicides among Danish cancer patients 1971-1999" 92 : 995-1000, 2005
• 5 Kinnaird A, "Recurrence and upstaging rates of T1 high-grade urothelial carcinoma of the bladder on repeat resection in a Canadian, resource-limited, healthcare system" 12 : 267-269, 2018
• 6 Krebber AM, "Prevalence of depression in cancer patients : a meta-analysis of diagnostic interviews and selfreport instruments" 23 : 121-130, 2014
• 7 Afshar M, "Patients with urological malignancy are 5times more likely to commit suicide: a large national cohort study" European Association of Urology 2018
• 8 Mohamed NE, "Muscle invasive bladder cancer : examining survivor burden and unmet needs" 191 : 48-53, 2014
• 9 Kok RM, "Management of depression in older adults : a review" 317 : 2114-2122, 2017
• 10 Cooke IJ, "Longitudinal impact of bladder cancer diagnosis on common psychiatric disorders" 10 : 8412-8420, 2021
• 11 Ferrell BR, "Integration of palliative care into standard oncology care : American Society of Clinical Oncology clinical practice guideline update" 35 : 96-112, 2017
• 12 Grunewald CM, "Impact of timing of adjuvant chemotherapy following radical cystectomy for bladder cancer on patient survival" 37 (37): e16017-, 2019
• 13 World Health Organization, "Depressive disorder (depression)" World Health Organization
• 14 National Comprehensive Cancer Network, "Bladder Cancer V.3" National Comprehensive Cancer Network