Factors disturbing treatment for cancer in patients with schizophrenia

Abstract

Patients with schizophrenia who develop cancer often have a variety of complicated medical and psychiatric problems. Problems associated with receiving a diagnosis of cancer and with understanding or cooperating with medical treatment may develop. Research in managing and treating schizophrenia patients with cancer is scarce. Presented herein is the experience of the authors' consultation-liaison psychiatry service in treating patients with schizophrenia who have cancer, and discussion of the medical management of such cases. Fourteen patients were treated between April 1999 and March 2003 and included patients receiving consultation psychiatric services at Shimane University Hospital as well as patients referred from other psychiatric hospitals. These patients were divided into two groups based on whether they were amenable to cancer treatment or not. The treated group consisted of patients who accepted cancer treatment, and the untreated group consisted of patients who refused or interrupted the cancer treatment. The clinical course, clinical psychiatric symptoms, problems in understanding cancer, cancer treatment course and convalescence were retrospectively assessed. Psychiatric symptoms and state were measured using the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). The mean of the duration of schizophrenia in these two groups was not significantly different. The mean scores on measures of psychiatric symptoms in each group (treated and untreated) were as follows: BPRS, 45.3 ± 15.4 and 64.9 ± 9.2 ( P < 0.05); positive symptoms scores on PANSS, 14.4 ± 8.8 and 20.6 ± 6.0 (NS); negative symptoms scores on PANSS, 20.6 ± 4.7 and 33.6 ± 4.4 ( P < 0.01); and total scores on PANSS, 31.7 ± 7.0 and 48.6 ± 7.4 ( P < 0.01). Patients with severe negative symptoms had greater difficulty understanding and cooperating with the cancer treatment. Regarding cancer stage, when cancer was discovered, the disease had already advanced and was no longer amenable to first-line treatment. Regarding notification of the diagnosis, it was rarely possible to give sufficiently early notice to patients in the untreated group. The important role of consultation-liaison psychiatrist in treating cancer patients is suggested. Some steps are proposed for managing schizophrenia patients with cancer who are not able to give informed consent.

Surgical management of colorectal cancer in patients with psychiatric disorders

“…If psychiatric symptoms are mild, attending psychiatrists may treat them in a general ward using the consultationliaison service. 3 The consultation-liaison service, which is the management of common psychiatric disorders in general practice, has received growing attention from physicians and the National Health Care System, recognizing that these disorders are common, but disabling, and that they incur social and economic costs. 13 We believe that a consultation-liaison service can provide the usual adequate mental health care for these patients and allow them to become familiar with the new environment.…”

“…These patients have diffi culties coping with the diagnosis and treatment of cancer and may ignore warning signs and symptoms because of their cognitive impairment. 3 Even when patients are conscious of their diagnosis and agree to undergo surgery, they are liable to encounter problems, despite the effectiveness of antipsychotic medication. 4,5 Thus, surgeons are required to practice special perioperative management considering the mental and surgical conditions of these patients.…”

Psychiatric disorders in advanced cancer

“…Taking care of schizophrenic patients with cancer can be challenging, as they frequently have poor insight and recall of medical recommendations, are often socially isolated and economically disadvantaged, may have problems with substance abuse, and are often diagnosed with late-stage disease because of lack of access to or poor compliance with primary care. [88][89][90] Therefore, close collaboration with mental health providers is advisable to ensure appropriate use of medications and community resources. Although some mentally ill patients may lack decision-making capacity around cancer treatment(s) or end-of-life care, data show that typical patients with serious mental illness are interested in advance care planning but often have not discussed it, are able to consider and communicate their preferences, and share the same end-of-life concerns as patients without mental illness, ie, pain and suffering, financial and emotional burden on family, saying ''goodbye,'' spiritual issues, and final arrangements.…”

Short-term outcomes of laparoscopic colorectal resection in psychiatric patients

“…Such patients have difficulty coping with the diagnosis and treatment of cancer, and they may ignore warning signs and symptoms of the disease because of their cognitive impairment [8] , which can result in riskier treatments having to be performed.…”