Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis

Davis, Laura; Bogner, Emma; Coburn, Natalie; Hanna, Timothy P.; Kurdyak, Paul; Groome, Patti A.; Mahar, Alyson

doi:10.1136/jech-2019-212311

Cited by 46 publications

(70 citation statements)

References 62 publications

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“…Further, our data lacked information on the stage of cancer. This is an important consideration given the likelihood that people with schizophrenia present with a more advanced stage of cancer at the time of diagnosis (Toender et al ., 2018) – a factor that has been associated with worse cancer survival in people with pre-existing mental disorders (Davis et al ., 2020). Others have documented a significantly higher proportion of individuals with evidence of metastatic disease at presentation in people with psychiatric illness (Kisely et al ., 2013).…”

Section: Discussionmentioning

confidence: 99%

The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

Pettersson

Gissler

Hällgren

et al. 2020

Epidemiol Psychiatr Sci

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Aims Decades of research show that people with schizophrenia have an increased risk of death from cancer; however, the relationship between schizophrenia and cancer incidence remains less clear. This population-based study investigates the incidence of seven common types of cancer among people with a hospital diagnosis of schizophrenia and accounting for the effects of age, sex and calendar time. Methods This population-based study used 1990–2013 data from three nationwide Swedish registries to calculate the incidence (in total, by age group and by sex) of any cancer and of lung, oesophageal, pancreatic, stomach, colon, (in men) prostate and (in women) breast cancer in 111 306 people with a hospital diagnosis of schizophrenia. The incidence in people with diagnosed schizophrenia was compared with the incidence in the general population. Risk estimates accounted for the effects of calendar time. Results In 1 424 829 person-years of follow-up, schizophrenia did not confer an overall higher cancer risk (IRR 1.02, 95% CI 0.91–1.13) but was associated with a higher risk for female breast (IRR 1.19, 95% CI 1.12–1.26), lung (IRR 1.42, 95% CI 1.28–1.58), oesophageal (IRR 1.25, 95% CI 1.07–1.46) and pancreatic (IRR 1.10, 95% CI 1.01–1.21) and a lower risk of prostate (IRR 0.66, 95% CI 0.55–0.79) cancer. Some age- and sex-specific differences in risk were observed. Conclusions People with schizophrenia do not have a higher overall incidence of cancer than people in the general population. However, there are significant differences in the risk of specific cancer types overall and by sex calling for efforts to develop disease-specific prevention programmes. In people with schizophrenia, higher risk generally occurs in those <75 years.

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Section: Discussionmentioning

confidence: 99%

The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

Pettersson

Gissler

Hällgren

et al. 2020

Epidemiol Psychiatr Sci

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“…The majority of evidence supporting this conclusion is based on a comparison of mortality rates in individuals with a psychiatric illness to a non-psychiatric population, rather than in comparing survival within cancer populations or is hampered by low study power and inappropriate control for intermediate variables on the causal pathway. Multiple cancer sites are sometimes grouped together in order to get an adequate sample size, despite the high probability that cancer-related prognosis is likely not uniformly worse across cancer sites [ 10 – 16 ]. Studies also control for many variables that make up the constellation of factors contributing to vulnerability, including socioeconomic status, which may underreport the magnitude of association [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study

et al. 2020

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Objectives To identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation. Design Population-based retrospective cohort study using linked cancer registry and administrative data at ICES. Setting The universal healthcare system in Ontario, Canada. Participants Colorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as ‘no history of mental illness, ‘outpatient SPI history’, and ‘inpatient SPI history’. Main outcome measures Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation. Results 24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36–2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04–1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07–4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72–2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses. Conclusions Individuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.

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“…45,46 Specifically, a recent meta-analysis of 28 studies identified pre-existing mental disorders to have a negative impact on timely diagnosis (odds ratio = OR = 1.19 [95% confidence interval = CI 1.06-1.33]) and survival (hazard ratio = HR = 1.43 [95% CI 1.20-1.71]) of cancer. 22 Large studies indicated the increase in cancer related mortality to be most severe in male patients with a mental comorbidity (24% increase in females, 39% increase in males) 47 and to positively correlate with the extent of prior use of psychiatric services. 48 Similarly, patients with a first-onset mental disorder diagnosed after the diagnosis of cancer were at increased risk of cancer-specific mortality (HR: 1.44-1.82).…”

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confidence: 99%

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

et al. 2021

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Background: Despite abundant evidence that emotional distress is frequent in cancer patients and associated with adverse health outcomes, distress screening rates and adequate referrals to psychological support programs among those in need are insufficient in many cancer centers. We therefore aimed to analyze patient-and treatment-related barriers to distress screening and referrals to psychological support as a mandatory component of best-practice cancer care. Method:In the present explorative study, latent class analysis was used to identify homogeneous subgroups among 4837 patients diagnosed with cancer between 2011 and 2019.Results: Four subgroups were identified. Patients with a mental disorder and psychopharmacology were least probable to be screened for distress. Together with patients aged 65 or older and male patients, they were also less likely to receive psychological support. Patients hospitalized for 28 days or longer were most likely to be both screened and to receive psychological support.Conclusions: Clinicians and researchers are recommended not neglect patients with mental disorders and psychopharmacological treatment as well as male and elderly patients when screening for distress and providing access to psychological support. K E Y W O R D Sdistress screening, latent class analysis, length of stay, psychiatric disorders, psycho-oncology, psychopharmacology 1 | BACKGROUND Psychological distress 1 has been reported in 30%-50% of cancer patients 2-7 and is persistent even in cancer survivors in 20%-40% of cases. 2,8 Such symptoms often remain unnoticed in primarily somatic treatment settings, 3,[9][10][11][12] even when pronounced psychopathology is present. 9,10,12 As a consequence, consensus-based treatment guidelines have recommended screening for distress in cancer patients as part of routine treatment. 13,14 The process of screening is recommended to facilitate access to psychosocial support to those in need. 15,16 Contrary to this, 25%-80% of patients with cancer do not receive screening. [17][18][19][20] Furthermore, even if identification of distressed patients with cancer is successful, this does not regularly result in referral to adequate psychological support. 9,16,21 A recent meta-analysis 22 and comprehensive review 23 both suggest patients with cancer and a pre-existing mental disorder are at particular risk to be neglected in terms of receiving psychological support. Patient

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Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis

Cited by 46 publications

References 62 publications

The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

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