Mental health implications in urologic cancer hospitalizations.

Abstract

74 Background: Increased mortality from urologic cancers coupled with an aging population has resulted in patient care becoming more specialized to improve patient outcomes. Though family history, lifestyle behaviors, and genetics are all used to determine risk and treatment, there is a knowledge gap of whether mental illness (MI) should also be considered. Therefore, this study seeks to determine whether hospitalizations of urologic cancers plus MIs are associated with increased all-cause mortality, length of hospital stay (LOS), costs of hospitalization and nosocomial infection rates. Methods: Inpatient data from 2016-2017 was obtained from the National Inpatient Sample database. This included all hospitalizations with at least one diagnosis of urologic cancer including prostate, bladder, kidney, renal pelvis, ureteral, urethral, testicular, and penile cancers. MIs of interest were depression, anxiety, substance abuse, and schizophrenia and related disorders. Data analysis and regression models were performed using SPSS Statistics. Reported odds ratios and significance values were controlled for Age, Sex, Income, Race, Insurance, Location, Mortality Risk, and Illness Severity. Results: There were 146,706 hospitalizations involving urologic cancers between 2016-2017. For these hospitalizations, depression and anxiety were associated with a decreased likelihood of death, and all MIs were associated with increased LOS. For hospitalizations involving prostate cancer, Depression and Substance Abuse were associated with decreased likelihood of death (all-causes). Hospitalizations involving kidney cancer had increased total charges and increased LOS. Hospitalizations involving bladder cancer were associated with decreased likelihood of death, and increased LOS for all MIs except, notably, those with substance abuse. Penile Cancer hospitalizations coded for anxiety showed increased LOS, and testicular cancer hospitalizations coded for substance abuse had increased likelihood of death. Conclusions: MIs can affect hospitalization outcomes of patients with urologic cancer differently based on the type of urologic cancer. Interestingly, our analysis showed that Depression was associated a decreased likelihood of death in hospitalizations coded for Prostate Cancer and Bladder Cancer. Though unexpected, we hypothesize that this finding may be partially due to implicit bias from healthcare providers that lead to enhanced care (e.g. increased patient monitoring, better support from auxiliary units such as Social Work). However, there is an absence of research in substantiating this claim. Further research is warranted to better assess the effect of Depression on the mortality of Urologic Cancer patients, and on how to best incorporate mental health status in the overall management of these patients.