Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;10(6):656-663.
doi: 10.1097/UPJ.0000000000000457. Epub 2023 Sep 26.

Inequities in Definitive Treatment for Localized Prostate Cancer Among Those With Clinically Significant Mental Health Disorders

Joshua Cabral  1 , Sarah K Holt  2   3 , Samuel L Washington 3rd  4   5 , Erin Dwyer  2 , Jenney R Lee  2 , Erika M Wolff  2 , John L Gore  2   3 , Yaw A Nyame  2   3
Affiliations

Inequities in Definitive Treatment for Localized Prostate Cancer Among Those With Clinically Significant Mental Health Disorders

Joshua Cabral et al. Urol Pract. 2023 Nov.

Abstract

Introduction: Patients with mental health disorders are at risk for receiving inequitable cancer treatment, likely resulting from various structural, social, and health-related factors. This study aims to assess the relationship between mental health disorders and the use of definitive treatment in a population-based cohort of those with localized, clinically significant prostate cancer.

Methods: We conducted a cohort study analysis in SEER (Surveillance, Epidemiology, and End Results)-Medicare (2004-2015). History of a mental health disorder was defined as presence of specific ICD (International Classification of Diseases)-9 or ICD-10 diagnostic codes in the 2 years preceding cancer diagnosis. Descriptive statistics were performed using Wilcoxon rank-sum and χ2 testing. Multivariable logistic regression was used to evaluate the relationship between mental health disorders and definitive treatment utilization (defined as surgery or radiation).

Results: Of 101,042 individuals with prostate cancer, 7,945 (7.8%) had a diagnosis of a mental health disorder. They were more likely to be unpartnered, have a lower socioeconomic status, and less likely to receive definitive treatment (61.8% vs 68.2%, P < .001). Definitive treatment rates were >66%, 62.8%, 60.3%, 58.2%, 54.3%, and 48.1% for post-traumatic stress disorder, depressive disorder, bipolar disorder, anxiety disorder, substance abuse disorder, and schizophrenia, respectively. After adjusting for age, race and ethnicity, marital status and socioeconomic status, history of a mental health disorder was associated with decreased odds of receiving definitive treatment (OR 0.74, 95% CI 0.66-0.83).

Conclusions: Individuals with mental health disorders and prostate cancer represent a vulnerable population; careful attention to clinical and social needs is required to support appropriate use of beneficial treatments.

Keywords: health services; healthcare disparities; mental health; prostatic neoplasms; race factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors report no relevant financial disclosures pertaining to this review article

Figures

Figure 1:
Figure 1:
The distribution of treatments by mental health diagnosis among men in SEER-Medicare (2004–2015) with localized, clinically significant prostate cancer
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Beatrici E, Trinh QD. Beatrici E, et al. Urol Pract. 2023 Nov;10(6):663-664. doi: 10.1097/UPJ.0000000000000457.01. Epub 2023 Sep 27. Urol Pract. 2023. PMID: 37856717 No abstract available.
  • Editorial Comment.
    Filipas DK, Cole AP. Filipas DK, et al. Urol Pract. 2023 Nov;10(6):664. doi: 10.1097/UPJ.0000000000000457.02. Epub 2023 Sep 27. Urol Pract. 2023. PMID: 37856719 No abstract available.

Similar articles

See all similar articles

References

    1. Knaak Stephanie, Mantler Ed, and Szeto Andrew. “Mental Illness-Related Stigma in Healthcare: Barriers to Access and Care and Evidence-Based Solutions.” Healthcare Management Forum 30, no. 2 (March 2017): 111–16. 10.1177/0840470416679413. - DOI - PMC - PubMed
    1. Kessler Ronald C., Berglund Patricia, Demler Olga, Jin Robert, Merikangas Kathleen R., and Walters Ellen E.. “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication.” Archives of General Psychiatry 62, no. 6 (June 1, 2005): 593. 10.1001/archpsyc.62.6.593. - DOI - PubMed
    1. Alegría Margarita, NeMoyer Amanda, Bagué Irene Falgàs, Wang Ye, and Alvarez Kiara. “Social Determinants of Mental Health: Where We Are and Where We Need to Go.” Current Psychiatry Reports 20, no. 11 (November 2018): 95. 10.1007/s11920-018-0969-9. - DOI - PMC - PubMed
    1. Hennekens Charles H., Hennekens Alissa R., Hollar Danielle, and Casey Daniel E.. “Schizophrenia and Increased Risks of Cardiovascular Disease.” American Heart Journal 150, no. 6 (December 2005): 1115–21. 10.1016/j.ahj.2005.02.007. - DOI - PubMed
    1. Laursen Thomas Munk, Munk-Olsen Trine, Nordentoft Merete, and Mortensen Preben Bo. “Increased Mortality Among Patients Admitted With Major Psychiatric Disorders: A Register-Based Study Comparing Mortality in Unipolar Depressive Disorder, Bipolar Affective Disorder, Schizoaffective Disorder, and Schizophrenia.” The Journal of Clinical Psychiatry 68, no. 06 (June 15, 2007): 899–907. 10.4088/JCP.v68n0612. - DOI - PubMed