THE RELATIONSHIP BETWEEN SMOKING STATUS AND POOR MENTAL HEALTH IN BLADDER CANCER PATIENTS AND SURVIVORS.

It is estimated that at least 50% of bladder cancer (BC) cases are linked to smoking, while persistent smoking after diagnosis is associated with higher risk of disease recurrence, higher rates of progression, adverse pathological response to neoadjuvant chemotherapy, and higher risk of developing metastatic disease and death. Yet, the association between smoking and mental health in this population is poorly understood. BC patients are usually burdened psychologically by stress, anxiety, and depression, irrespective of the stage of disease or timing and treatment modality. We sought to investigate the association between smoking status and mental health among patients and survivors of BC. Using the CDC national Behavioral Risk Factor Surveillance System (BRFSS) cycles between 2016 and 2021, we conducted a cross-sectional study of participants who self-reported ever being diagnosed with BC. A descriptive analysis of our study cohort was conducted (Table 1). Further, we used a multivariable logistic regression analysis (MVA) to examine the association between smoking status and the outcome of self-reported 14+ days per month when mental health is not good. We hypothesized that smoking is associated with worse mental health. In our MVA (Table 2) we adjusted our analysis for age, time from being diagnosed to undergoing the survey in years, treatment status, income, marital status, exercise and physical activity, BMI, history of depression, history of coronary heart disease or myocardial infraction, and history of chronic kidney disease. An institutional review board waiver was obtained given the use of de-identified data. Two-sided statistical significance was defined as P<0.05. We identified 1,118 BC patients and survivors out of 2,632,647 participants in the 2016 to 2021 BRFSS. 188 (16.9%) were current smokers, 584 (52.5%) were former smokers, and 341 (30.6%) had never smoked. Among the BC cohort, only 104 (9.3%) individuals reported 14+ days per month when mental health was not good. (Table 1). Our MVA showed that being a current smoker is independently associated with worse mental health compared to being a never smoker (OR 2.41, 95% CI 1.06 – 5.50, p=0.04), while being a former smoker was not an independent predictor of worse mental health (OR 0.96, 95% CI 0.46 – 2.00, p=0.91). Other significant predictors of poor mental health can be seen in Table 2. Standard logistic regression diagnostics for our MVA yielded a Hosmer-Lemeshow goodness of fit test p=0.88, and a receiver operating characteristic (ROC) with an area under the curve (AUC) of 0.81. Our results indicate an independent association between being a current smoker and reported poor mental health in BC patients and survivors. Moreover, being a former smoker was not associated with poor mental health. Our results are profound and significant due to the well-known implications of smoking in the development of bladder cancer. Our findings bring a piece of valuable clinical information to this specific population and supports the importance of smoking cessation programs. An important strength of our study is the large national sample size. Limitations include the lack of granularity in staging and treatment-specific data and traditional biases inherited from retrospective studies. Since smoking behavior is modifiable, our findings should encourage the implementation of smoking cessation programs in BC patients and survivors in order to improve mental health and quality of life. [ABSTRACT FROM AUTHOR]