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

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.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4939-8) contains supplementary material, which is available to authorized users.

The Association between Selective Serotonin Reuptake Inhibitors (SSRIs) Use and the Risk of Bladder Cancer: A Nationwide Population-Based Cohort Study

“…In our review, there was only one study investigating the possible associations between antidepressants (including SSRIs, SNRIs, MAOIs, and TCA) and invasive bladder cancer [14]. Steffensen et al performed a national population-based cohort study in Denmark enclosing all cases with invasive bladder cancer during 2005-2015 [14].…”

“…In our review, there was only one study investigating the possible associations between antidepressants (including SSRIs, SNRIs, MAOIs, and TCA) and invasive bladder cancer [14]. Steffensen et al performed a national population-based cohort study in Denmark enclosing all cases with invasive bladder cancer during 2005-2015 [14]. The results showed that antidepressants use as a whole in the year before cancer diagnosis was associated with less advanced cancer at diagnosis (aOR = 0.86, 95% CI = 0.74-0.99) [14].…”

“…Steffensen et al performed a national population-based cohort study in Denmark enclosing all cases with invasive bladder cancer during 2005-2015 [14]. The results showed that antidepressants use as a whole in the year before cancer diagnosis was associated with less advanced cancer at diagnosis (aOR = 0.86, 95% CI = 0.74-0.99) [14]. Compared to their study, our study specifically focused on the impact of all SSRIs as a group and each SSRI on bladder cancer risk.…”

“…We also included all stages of bladder cancer in our analysis, instead of invasive bladder cancer only. Besides, this study did not adjust for comorbid psychiatric disorders [14]. As previous studies have shown, mood and anxiety disorder were known to have impacts on diagnosis and mortality of cancers [21][22][23][24][25].…”

“…For example, three population-based studies reported that SSRIs are associated with a lower risk of cancer (i.e., hepatocellular carcinoma, liver, and ovarian cancer) [11][12][13]. A separate study suggested that antidepressant prescription before bladder cancer diagnosis was associated with a lower degree of invasiveness and severity of cancer at the time of diagnosis [14]. Moreover, some animal and human cell in-vitro studies have also demonstrated the tumor suppression effect of SSRIs [15][16][17][18][19][20].…”