End of life breast cancer care in women with severe mental illnesses

Abstract

Little is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357–1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

“…Previous work focusing on specific phases of cancer care in this vulnerable group has consistently highlighted less access to cancer screening [ 21 , 22 ] and lower care intensity than for the general population [ 23 , 24 , 25 , 26 , 27 ]. Many of the factors that contribute to the excess mortality in persons with SMI are therefore likely to stem from institutional and policy-level issues in care pathways, making this excess mortality a question of human rights and equity.…”

NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review

“…Multiple studies reveal that healthcare for people with SPMI is not equitable [ 14 , 15 , 16 , 17 , 19 , 21 , 25 , 26 , 39 , 45 , 65 , 66 , 67 , 68 , 69 ]. Ethical challenges such as withheld treatments due to SPMIs and concerns about risks to other patients [ 67 ], fewer referrals and admissions to palliative and quality end-of-life care [ 14 , 15 , 16 , 25 , 45 , 68 ], and being subjected to more invasive end-of-life treatments, such as intubation, CPR, and feeding tubes [ 47 ], and being denied access to mental health care teams in their healthcare setting [ 16 ] were described.…”

“…Multiple studies reveal that healthcare for people with SPMI is not equitable [ 14 , 15 , 16 , 17 , 19 , 21 , 25 , 26 , 39 , 45 , 65 , 66 , 67 , 68 , 69 ]. Ethical challenges such as withheld treatments due to SPMIs and concerns about risks to other patients [ 67 ], fewer referrals and admissions to palliative and quality end-of-life care [ 14 , 15 , 16 , 25 , 45 , 68 ], and being subjected to more invasive end-of-life treatments, such as intubation, CPR, and feeding tubes [ 47 ], and being denied access to mental health care teams in their healthcare setting [ 16 ] were described. The United Nations Convention on the Rights of Persons with Disabilities’ (UNCRPD) purpose is to “promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms” and to “promote respect for their inherent dignity of people with disabilities” [ 70 ] (p. 4).…”

Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta‐analysis

“…Relative risk (RR) and 95% confidence intervals (CI) for receiving guideline-appropriate treatment were calculated from raw data in some studies. 21,[39][40][41][42] However, these measures were not included in the meta-analysis as they were not adjusted for possible confounding. In the study by Ahlgrén et al (2020), 21 we attempted to calculate RR for receiving guideline recommended treatment in SMI and non-SMI groups by combining all treatment modalities together (e.g., chemotherapy, radiotherapy, and hormonal therapy), so that we could compare it with similar treatments.…”

“…Our search identified 3625 citations, of which 13 studies were included in the review 4,19,21,[39][40][41][42][43][44][49][50][51][52] and 4 contributed to the metaanalyses. 40,43,44,52 (Figure 1).…”