Abstract
BackgroundAmong 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.MethodsWe 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.ResultsAmong 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%).ConclusionsAntidepressant 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.
Highlights
Among cancer patients, prior antidepressant use has been associated with impaired survival
We examined the association between antidepressant use and stage at diagnosis (muscle-invasive or non-muscle-invasive) or surgery (organ confined or non-organ confined) using logistic regression, adjusting for age at diagnosis, sex, Charlson Comorbidity Index (CCI) score (0, 1–2, 3+), alcohol-related disorders, and marital status at diagnosis
Due to missing data for tumor stage at diagnosis and at surgery, two sensitivity analyses were performed to increase the proportion of individuals with stage data: we restricted the analysis of stage at diagnosis to patients diagnosed during 2011–2015, and we repeated the analysis of stage at surgery including the latest stage recorded before surgery, if stage at surgery was missing
Summary
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, 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. Comorbidity raises complication risk [3], and bladder cancer patients are increasingly comorbid [4], with increased medication use including antidepressants as a consequence. In a Danish setting, use of antidepressants detects patients suffering from a depression with a specificity of 94% to 97% [7]. This makes prescription data about antidepressants suited for identification of patients with depression in Denmark, where more than 90% of such patients are treated by general practitioners [7]; the treatment in these cases is not recorded in hospital registries
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