Preadmission antidepressant use and bladder cancer: A population-based cohort study of stage at diagnosis, time to surgery, and surgical outcomes

Ellen Hollands Steffensen, K. Clinton Cary, Jørgen Bjerggaard Jensen, Heidi Larsson, Michael Weiner, Mette Nørgaard

Research output: Contribution to journalArticle

Abstract

Background: Among cancer patients, prior antidepressant use has been associated with impaired survival. This could be due to differences in stage at diagnosis, in receipt of treatment, or in treatment complications. The purpose of this study was, therefore, to examine if preadmission antidepressant use in patients with bladder cancer is associated with tumor stage at diagnosis, rate of cystectomy, and surgical outcomes, including survival. Methods: We performed a registry-based cohort study including all patients with incident invasive bladder cancer in Denmark 2005-2015. Exposure was defined as redemption of two or more antidepressant prescriptions one year before cancer diagnosis. We compared tumor stage using logistic regression, postsurgical inpatient length of stay using linear regression, and other outcomes using Cox regression. All results were adjusted for age, sex, comorbidity, and marital status. Results: Among 10,427 bladder cancer patients, 10% were antidepressant users. At diagnosis, 51% of users and 52% of non-users had muscle-invasive disease. However, upon adjustment for age, sex, comorbidity, and marital status, users had lower odds of muscle-invasive disease (adjusted odds ratio 0.86 (95% confidence interval (CI) 0.74-0.99)). Among patients with muscle-invasive disease, fewer users than non-users had surgery within three months (15% vs. 24%, adjusted hazard ratio (aHR) 0.75 (95% CI 0.59-0.95)). Of 2532 patients undergoing surgery, 6% were antidepressant users. Postsurgical inpatient length of stay did not differ between users and non-users. The 30-day cumulative incidence of readmission was higher for users (41% vs. 33%, aHR 1.33 (95% CI 1.05-1.67)), while the 90-day incidence of postoperative procedures was 44% for users and 38% for non-users (aHR 1.18 (95% CI 0.93-1.51)). One-year mortality was comparable in users (15%) and non-users (14%). Conclusions: Antidepressant use in bladder cancer patients was associated with less advanced stage at diagnosis and lower rate of cystectomy. After cystectomy, users had higher rate of readmission and postoperative procedures than non-users, but we found no difference in length of stay or one-year mortality. The results point to the importance of differentiated clinical care according to individual patient characteristics.

Original languageEnglish (US)
Article number1035
JournalBMC Cancer
Volume18
Issue number1
DOIs
StatePublished - Oct 24 2018

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Urinary Bladder Neoplasms
Antidepressive Agents
Cohort Studies
Population
Cystectomy
Confidence Intervals
Length of Stay
Postoperative Care
Marital Status
Muscles
Comorbidity
Inpatients
Neoplasms
Survival
Mortality
Incidence
Denmark
Prescriptions
Registries
Linear Models

Keywords

  • Antidepressive agents
  • Cystectomy
  • Delayed diagnosis
  • Treatment outcome
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Preadmission antidepressant use and bladder cancer : A population-based cohort study of stage at diagnosis, time to surgery, and surgical outcomes. / Steffensen, Ellen Hollands; Cary, K. Clinton; Jensen, Jørgen Bjerggaard; Larsson, Heidi; Weiner, Michael; Nørgaard, Mette.

In: BMC Cancer, Vol. 18, No. 1, 1035, 24.10.2018.

Research output: Contribution to journalArticle

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AU - Cary, K. Clinton

AU - Jensen, Jørgen Bjerggaard

AU - Larsson, Heidi

AU - Weiner, Michael

AU - Nørgaard, Mette

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N2 - Background: Among cancer patients, prior antidepressant use has been associated with impaired survival. This could be due to differences in stage at diagnosis, in receipt of treatment, or in treatment complications. The purpose of this study was, therefore, to examine if preadmission antidepressant use in patients with bladder cancer is associated with tumor stage at diagnosis, rate of cystectomy, and surgical outcomes, including survival. Methods: We performed a registry-based cohort study including all patients with incident invasive bladder cancer in Denmark 2005-2015. Exposure was defined as redemption of two or more antidepressant prescriptions one year before cancer diagnosis. We compared tumor stage using logistic regression, postsurgical inpatient length of stay using linear regression, and other outcomes using Cox regression. All results were adjusted for age, sex, comorbidity, and marital status. Results: Among 10,427 bladder cancer patients, 10% were antidepressant users. At diagnosis, 51% of users and 52% of non-users had muscle-invasive disease. However, upon adjustment for age, sex, comorbidity, and marital status, users had lower odds of muscle-invasive disease (adjusted odds ratio 0.86 (95% confidence interval (CI) 0.74-0.99)). Among patients with muscle-invasive disease, fewer users than non-users had surgery within three months (15% vs. 24%, adjusted hazard ratio (aHR) 0.75 (95% CI 0.59-0.95)). Of 2532 patients undergoing surgery, 6% were antidepressant users. Postsurgical inpatient length of stay did not differ between users and non-users. The 30-day cumulative incidence of readmission was higher for users (41% vs. 33%, aHR 1.33 (95% CI 1.05-1.67)), while the 90-day incidence of postoperative procedures was 44% for users and 38% for non-users (aHR 1.18 (95% CI 0.93-1.51)). One-year mortality was comparable in users (15%) and non-users (14%). Conclusions: Antidepressant use in bladder cancer patients was associated with less advanced stage at diagnosis and lower rate of cystectomy. After cystectomy, users had higher rate of readmission and postoperative procedures than non-users, but we found no difference in length of stay or one-year mortality. The results point to the importance of differentiated clinical care according to individual patient characteristics.

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KW - Antidepressive agents

KW - Cystectomy

KW - Delayed diagnosis

KW - Treatment outcome

KW - Urinary bladder neoplasms

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