Abstract
BackgroundAdvanced cancer stage at diagnosis may explain high cancer mortality among patients with a severe psychiatric illness (SPI). Studies to date investigating advanced stage cancer at diagnosis as a potential explanation for high cancer mortality in individuals with a history of mental illness have been inconclusive. We examined the relationship between a SPI history and unknown cancer stage at diagnosis in colorectal cancer (CRC) patients.MethodsThis was a population-based, cross-sectional study using linked administrative databases of CRC patients diagnosed between 01/04/2007 and 31/12/2012. Individuals who had a history of mental illness but did not meet the definition of a SPI were excluded. An SPI was measured in the 5 years prior to the cancer diagnosis and categorized as inpatient, outpatient or no SPI. Individuals with a best stage in Stage 0 to Stage IV were considered staged and absence of staging information was defined as unknown stage. The risk of unknown stage cancer was estimated using modified Poisson regression.ResultsThe final study cohort included 24,507 CRC patients. 258 (1.1%) individuals experienced a history of inpatient SPI and 482 (2.0%) experienced outpatient SPI. After adjusting for confounders, CRC patients with an inpatient or outpatient history of SPI were at greater risk of having missing TNM stage at diagnosis, compared to patients with no history of a mental illness (RR 1.45 (95% CI: 1.14–1.85) and RR1.17 (95% CI 0.95–1.43), respectively). The results did not change when alternate practices to assign SPI history using administrative data were used.ConclusionsIndividuals with an SPI, especially those with a psychiatric admission, were more likely to have missing stage data compared to individuals without a history of a mental illness. Incomplete and low quality cancer staging data likely undermines the quality of cancer care following initial diagnosis. Understanding why patients with an SPI are missing this information is a critical first step to providing excellent care to this vulnerable population.
Highlights
Advanced cancer stage at diagnosis may explain high cancer mortality among patients with a severe psychiatric illness (SPI)
Advanced stage cancer at diagnosis has been suggested as a potential explanation for worse cancer case fatality in individuals with a history of mental illness compared with the rest of the cancer population [1,2,3]
In patients with colorectal cancer identified in the Surveillance, Epidemiology and End Results cancer registry, patients with a SPI history had a greater proportion of unknown stage of cancer at diagnosis (14%) compared to the general cancer population (6.2%) [13]
Summary
Advanced cancer stage at diagnosis may explain high cancer mortality among patients with a severe psychiatric illness (SPI). Individuals with a severe psychiatric illness (SPI) history may be at increased risk for incurable stage cancer through a number of patient factors (e.g. low socioeconomic status), provider factors (e.g. diagnostic overshadowing) and healthcare system factors (fragmented healthcare) [4,5,6]. These factors are established risk factors for advanced stage of cancer at diagnosis [7,8,9]. The proportion of patients with missing stage data was extremely high in persons with a psychotic disorder (22.9%) [13]
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