Cancer mortality in patients with schizophrenia

Abstract

BACKGROUND: Schizophrenia has been associated with a rate of premature mortality that is 2 to 3 times higher than that in the general population. Although the role of cancer in this excess mortality remains unclear, previous incidence or mortality studies found contradictory results. METHODS: In 1993, a large prospective study was initiated in a cohort of 3470 patients with schizophrenia to examine cancer‐related mortality and predictors. Standardized mortality ratios (SMRs) were calculated, adjusting for age and sex relative to a representative sample of the French general population. RESULTS: During the 11‐year follow‐up, 476 (14%) patients died; the mortality rate was thus nearly 4‐fold higher than in the general population. Cancer was the second most frequent cause of mortality (n = 74), with a global SMR of 1.5 (95% confidence interval [95% CI], 1.2‐1.9). For all cancers, the SMRs were 1.4 (not significant) for men and 1.9 (95% CI, 1.4‐2.8) for women. For men, lung cancer was the most frequent localization (n = 23; 50%), with an SMR of 2.2 (95% CI, 1.6‐3.3). For women, breast cancer was the most frequent localization (n = 11; 39%), with an SMR of 2.8 (95% CI, 1.6‐4.9). In comparison with patients who did not die of cancer, there were 2 significant baseline predictors of death by lung cancer in the final logistic regression model: duration of smoking and age >38 years. CONCLUSIONS: The results of the current study demonstrated an increased risk of mortality by cancer in patients with schizophrenia, especially for women from breast cancer and for men from lung cancer. Cancer 2009. © 2009 American Cancer Society.

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

“…In another study based on the linked data from death certificates and the mental health system in Ohio, Musuuza et al (14) reported higher standardized mortality rates (SMRs) of lung cancer among people with mental illness than the general population, with SMRs ranging from 3 to 5 times higher stratified by race and gender, respectively (14). With respect to specific mental health disorders, a French study observed a more than 2-fold increase in the mortality of lung cancer among men with schizophrenia compared to the general population (13). Two other cohort studies identified psychological stress (12) and schizophrenia (21) as significant may exist for the observed associations in these studies.…”

“…Non-small cell lung cancer (NSCLC) comprises 85% to 90% of all lung cancers (30). Previous studies have found increased mortality among lung cancer patients with mental illness (1, 10, 11, 13, 14, 31, 32). However, it is not clear what factors may contribute to the increased mortality while it can be reasonably postulated that treatment and treatment adherence may differ between patients with and without a mental health disorder.…”

Impact of socioeconomic deprivation on rate and cause of death in severe mental illness

“…In particular, and perhaps surprisingly, deaths due to cancer and alcohol were lower in the SMI group compared to the Glasgow group. To date, the literature surrounding cancer deaths in individuals with SMI has been mixed, with some studies reporting elevated rates [31], while others report lower rates of cancer deaths [32]. A recent meta-analysis of incidence of cancer [33], reported that pooled overall rates of cancer incidence were not significantly increased in individuals with schizophrenia compared to controls (Standardised Incidence Rate (SIR) 1.05, 95% CI 0.95-1.15) and although incidence of lung cancer was increased, when adjusted for smoking there was no difference in incidence rates.…”

Increased Mortality in Schizophrenia Due to Cardiovascular Disease – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

“…Death from unnatural causes appears to be 10–20 times higher in schizophrenia than in the general population (2, 4, 13). Suicide and accidents accounted for about 40% of the extra deaths, while 60% were from natural causes (4, 8, 14, 15). …”