Mental health implications in bladder cancer patients: A review

Although the majority of bladder cancer literature has been dedicated to optimizing oncological outcomes and focuses on physical prognostic criteria such as nutritional and performance status, emerging data has suggested that both pre- and post-treatment mental health may play as important a role in patient outcomes as physical health. In this review, we summarize the literature regarding the prognostic implications of mental illness on bladder cancer patients and review how both the diagnosis and treatment of bladder cancer can affect mental health across various disease states. Literature review via a modified, nonsystematic analysis was performed from 2000 to 2018 in PubMed, Web of Science, EMBASE, SCOPUS, and OVID. Search terms included "bladder cancer," "non-muscle-invasive bladder cancer," "muscle-invasive bladder cancer," "mental health," "psychological distress," "depression," and "suicide." Articles were limited to English-language, peer-reviewed, original research. A total of 87 publications were reviewed that met our initial inclusion criteria, and 19 relevant publications were incorporated in our review. Eleven studies were prospective and 8 were retrospective. Two articles included non-muscle-invasive bladder cancer patients, 11 included muscle-invasive bladder cancer patients, and 6 incorporated bladder cancer patients across all disease stages. Mental health issues, such as depression and anxiety, often coexist with a diagnosis of bladder cancer with a worse prognosis associated with greater psychological burden. Bladder cancer patients also have an increased risk of suicide especially in older, unmarried, male patients with more advanced disease states. Poor mental health can impact treatment outcomes such as postsurgical complication rates as well as survival-related outcomes similar to physical health. While awareness of the importance of mental health in bladder cancer patients is growing, further studies are needed to assess the role of interventions such as cognitive behavioral therapy or pharmacotherapy in order to optimize treatment.