The impact of radical cystectomy and urinary diversion on suicidal death in patients with bladder cancer

Zachary W A Klaassen, John M. DiBianco, Rita P. Jen, Benjamin Harper, Grace Yaguchi, Lael Reinstatler, Cynthia Woodard, Kelvin A. Moses, Martha Kennedy Terris, Rabii Hussein Madi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

PURPOSE: Compared to the general population, suicide is more common in the elderly and in patients with cancer. We sought to examine the incidence of suicide in patients with bladder cancer and evaluate the impact of radical cystectomy in this high-risk population. METHODS: Patients diagnosed with urothelial carcinoma from 1988 to 2010 were identifi ed in the Survey, Epidemiology, and End Results (SEER) database. Contingency tables of suicide rates and standardized mortality ratios (SMRs) and 95% confi dence intervals were calculated. Multivariable logistic regression models were performed to generate odds ratios (ORs) for the identifi cation of factors associated with suicide in this population. RESULTS: There were 439 suicides among patients with bladder cancer observed for 1,178,000 person-years (Standard Morbidity Ratio [SMR] = 2.71). All demographic variables analyzed had a higher SMR for suicide compared to the general population, in particular age ≥ 80 years (SMR = 3.12), unmarried status (SMR = 3.41), and white race (SMR = 2.60). The incidence of suicide was higher in the general population for patients who underwent radical cystectomy compared to those who did not (SMR = 3.54 vs SMR = 2.66). On multivariate analysis, the strongest predictors of suicide were male gender (vs female; OR = 6.63) and distant disease (vs localized; OR = 5.43). CONCLUSIONS: Clinicians should be aware of risk factors for suicide in patients diagnosed with bladder cancer, particularly older, white, unmarried patients with distant disease, and/or those who have undergone radical cystectomy. A multidisciplinary team-based approach, including wound ostomy care trained nursing staff and mental health care providers, may be essential to provide care required to decrease suicide rates in this at-risk population.

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalJournal of Wound, Ostomy and Continence Nursing
Volume43
Issue number2
DOIs
StatePublished - Mar 23 2016

Fingerprint

Urinary Diversion
Cystectomy
Urinary Bladder Neoplasms
Suicide
Mortality
Population
Odds Ratio
Logistic Models
Ostomy
Nursing Staff
Incidence
Health Personnel
Cations
Mental Health
Epidemiology
Multivariate Analysis
Demography
Databases
Morbidity
Carcinoma

Keywords

  • Bladder cancer
  • Marital status
  • Ostomy
  • Race
  • SEER
  • Suicide
  • Urinary diversion
  • Wound and ostomy nursing

ASJC Scopus subject areas

  • Medical–Surgical
  • Advanced and Specialized Nursing

Cite this

The impact of radical cystectomy and urinary diversion on suicidal death in patients with bladder cancer. / Klaassen, Zachary W A; DiBianco, John M.; Jen, Rita P.; Harper, Benjamin; Yaguchi, Grace; Reinstatler, Lael; Woodard, Cynthia; Moses, Kelvin A.; Terris, Martha Kennedy; Madi, Rabii Hussein.

In: Journal of Wound, Ostomy and Continence Nursing, Vol. 43, No. 2, 23.03.2016, p. 152-157.

Research output: Contribution to journalArticle

Klaassen, Zachary W A ; DiBianco, John M. ; Jen, Rita P. ; Harper, Benjamin ; Yaguchi, Grace ; Reinstatler, Lael ; Woodard, Cynthia ; Moses, Kelvin A. ; Terris, Martha Kennedy ; Madi, Rabii Hussein. / The impact of radical cystectomy and urinary diversion on suicidal death in patients with bladder cancer. In: Journal of Wound, Ostomy and Continence Nursing. 2016 ; Vol. 43, No. 2. pp. 152-157.
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abstract = "PURPOSE: Compared to the general population, suicide is more common in the elderly and in patients with cancer. We sought to examine the incidence of suicide in patients with bladder cancer and evaluate the impact of radical cystectomy in this high-risk population. METHODS: Patients diagnosed with urothelial carcinoma from 1988 to 2010 were identifi ed in the Survey, Epidemiology, and End Results (SEER) database. Contingency tables of suicide rates and standardized mortality ratios (SMRs) and 95{\%} confi dence intervals were calculated. Multivariable logistic regression models were performed to generate odds ratios (ORs) for the identifi cation of factors associated with suicide in this population. RESULTS: There were 439 suicides among patients with bladder cancer observed for 1,178,000 person-years (Standard Morbidity Ratio [SMR] = 2.71). All demographic variables analyzed had a higher SMR for suicide compared to the general population, in particular age ≥ 80 years (SMR = 3.12), unmarried status (SMR = 3.41), and white race (SMR = 2.60). The incidence of suicide was higher in the general population for patients who underwent radical cystectomy compared to those who did not (SMR = 3.54 vs SMR = 2.66). On multivariate analysis, the strongest predictors of suicide were male gender (vs female; OR = 6.63) and distant disease (vs localized; OR = 5.43). CONCLUSIONS: Clinicians should be aware of risk factors for suicide in patients diagnosed with bladder cancer, particularly older, white, unmarried patients with distant disease, and/or those who have undergone radical cystectomy. A multidisciplinary team-based approach, including wound ostomy care trained nursing staff and mental health care providers, may be essential to provide care required to decrease suicide rates in this at-risk population.",
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AU - Yaguchi, Grace

AU - Reinstatler, Lael

AU - Woodard, Cynthia

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N2 - PURPOSE: Compared to the general population, suicide is more common in the elderly and in patients with cancer. We sought to examine the incidence of suicide in patients with bladder cancer and evaluate the impact of radical cystectomy in this high-risk population. METHODS: Patients diagnosed with urothelial carcinoma from 1988 to 2010 were identifi ed in the Survey, Epidemiology, and End Results (SEER) database. Contingency tables of suicide rates and standardized mortality ratios (SMRs) and 95% confi dence intervals were calculated. Multivariable logistic regression models were performed to generate odds ratios (ORs) for the identifi cation of factors associated with suicide in this population. RESULTS: There were 439 suicides among patients with bladder cancer observed for 1,178,000 person-years (Standard Morbidity Ratio [SMR] = 2.71). All demographic variables analyzed had a higher SMR for suicide compared to the general population, in particular age ≥ 80 years (SMR = 3.12), unmarried status (SMR = 3.41), and white race (SMR = 2.60). The incidence of suicide was higher in the general population for patients who underwent radical cystectomy compared to those who did not (SMR = 3.54 vs SMR = 2.66). On multivariate analysis, the strongest predictors of suicide were male gender (vs female; OR = 6.63) and distant disease (vs localized; OR = 5.43). CONCLUSIONS: Clinicians should be aware of risk factors for suicide in patients diagnosed with bladder cancer, particularly older, white, unmarried patients with distant disease, and/or those who have undergone radical cystectomy. A multidisciplinary team-based approach, including wound ostomy care trained nursing staff and mental health care providers, may be essential to provide care required to decrease suicide rates in this at-risk population.

AB - PURPOSE: Compared to the general population, suicide is more common in the elderly and in patients with cancer. We sought to examine the incidence of suicide in patients with bladder cancer and evaluate the impact of radical cystectomy in this high-risk population. METHODS: Patients diagnosed with urothelial carcinoma from 1988 to 2010 were identifi ed in the Survey, Epidemiology, and End Results (SEER) database. Contingency tables of suicide rates and standardized mortality ratios (SMRs) and 95% confi dence intervals were calculated. Multivariable logistic regression models were performed to generate odds ratios (ORs) for the identifi cation of factors associated with suicide in this population. RESULTS: There were 439 suicides among patients with bladder cancer observed for 1,178,000 person-years (Standard Morbidity Ratio [SMR] = 2.71). All demographic variables analyzed had a higher SMR for suicide compared to the general population, in particular age ≥ 80 years (SMR = 3.12), unmarried status (SMR = 3.41), and white race (SMR = 2.60). The incidence of suicide was higher in the general population for patients who underwent radical cystectomy compared to those who did not (SMR = 3.54 vs SMR = 2.66). On multivariate analysis, the strongest predictors of suicide were male gender (vs female; OR = 6.63) and distant disease (vs localized; OR = 5.43). CONCLUSIONS: Clinicians should be aware of risk factors for suicide in patients diagnosed with bladder cancer, particularly older, white, unmarried patients with distant disease, and/or those who have undergone radical cystectomy. A multidisciplinary team-based approach, including wound ostomy care trained nursing staff and mental health care providers, may be essential to provide care required to decrease suicide rates in this at-risk population.

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