Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy

Abstract

Objective: To examine cancer-related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008-2017 and compare it with the regional population. Methods:We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD-9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10-year period (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period.Results: Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%-29%) died of cancer.In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site-specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender.Conclusions: Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho-oncology.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action

“…Mortality in patients with SMI, especially those affected by schizophrenia and schizophrenic spectrum disorders, has been the object of several studies which indicated a higher mortality rate in patients with SMI and cancer in several countries 35 . In this issue, these data were confirmed by the only research submitted on this topic, a 10‐year follow‐up study of almost 3000 patients with schizophrenia and bipolar spectrum disorders who died from cancer in Northern Italy 36 . The authors found a higher mortality rate (50% higher) for cancer in patients with SMI with respect to the general population and a higher proportion of deaths in the younger age class among patients with SMI than among the general population.…”

“…35 In this issue, these data were confirmed by the only research submitted on this topic, a 10-year follow-up study of almost 3000 patients with schizophrenia and bipolar spectrum disorders who died from cancer in Northern Italy. 36 The authors found a higher mortality rate (50% higher) for cancer in patients with SMI with respect to the general population and a higher proportion of deaths in the younger age class among patients with SMI than among the general population.…”

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

“…Research carried out in one Australian state for different cancer sites showed similar results, with a higher proportion of cancer with metastases at diagnosis, a reduced likelihood of surgery and radiotherapy, and fewer chemotherapy sessions overall among the population with SMI [ 11 ]. Despite a relative consistency in these first findings, there is still a dearth of research resorting to linked data between community and hospital care to comprehensively document cancer care pathways for people with SMI in different national settings, using large sample sizes, consensual indicators of care quality within the context of clinical guidelines, and a control group, as recently advocated [ 31 , 32 , 33 , 34 ].…”

Issues of cancer care in people with mental disorders as perceived by cancer care providers: A quantitative questionnaire survey

“…Cancer is one of the leading causes of death in people with mental disorders 1,2 . Although cancer incidence rates in those with a mental illness are equal to, or lower than, in those without a mental disorder, 3,4 cancer mortality rates in people with mental disorders are high 2,5–9 . Previous reports have shown that people with a severe mental illness are more likely to have delayed cancer detection and less likely to receive standard treatments for cancer than those without a severe mental illness 10,11 .…”

“…1,2 Although cancer incidence rates in those with a mental illness are equal to, or lower than, in those without a mental disorder, 3,4 cancer mortality rates in people with mental disorders are high. 2,[5][6][7][8][9] Previous reports have shown that people with a severe mental illness are more likely to have delayed cancer detection and less likely to receive standard treatments for cancer than those without a severe mental illness. 10,11 Moreover, other reports have shown that people with schizophrenia receive less palliative care and fewer opioid prescriptions.…”