Patients with schizophrenia and breast cancer: Adjuvant radiation treatment.

Abstract

e17506 Background: Schizophrenia affects about 1% of subjects in all populations studied so far. It impairs medical care delivery. We sought to evaluate how patients with schizophrenia who are later diagnosed with breast carcinoma fare when adjuvant radiation therapy (ART) is indicated. Methods: We searched the Patient Treatment File (PTF) of the Department of Veterans Affairs (DVA) to identify subjects with schizophrenia who later developed breast carcinoma and were treated in DVA Medical Centers (DVAMCs) from 1999 - 2005. Chart-based clinical data from the DVAMCs where the subjects had been treated supplemented PTF data. Results: 42 patients had preexisting schizophrenia, later developed breast carcinoma, and were candidates for ART. There were 31 women (74%) and 11 men (26%). 27 of the 42 study subjects had records specifying TNM stage; 18 of the 27 (67%) had TNM stages III-IV. 31 subjects had records about compliance with indicated medical therapies; 24 (77%) had previously been non-compliant. 39 subjects had records regarding therapy delay; 20 (51%) had previously delayed medically indicated therapy. Of the 42 subjects who were candidates for ART based on TNM stage, we found data about the decision to recommend ART in 37; only 23 (26%) were offered ART and 3 of those 23 (26%) refused it. Of the 6 subjects who refused ART, 4 had been non-compliant with previous medically indicated care, 3 had delayed initial cancer treatment, 4 had documented suicidal ideation, and 2 had documented homicidal ideation before being offered ART. Conclusions: Subjects with schizophrenia and breast carcinoma often do not understand their illnesses well. They often do not comply with recommended standard therapies such as ART. Treatments that rely on ART are likely to be met with non-compliance. A history of non-compliance appears to be a predictor of non-compliance with ART. Our results should be of interest to caregivers because we describe ways to avoid suboptimal ART in patients with breast carcinoma. Breast-conserving multi-modality treatment with ART is frequently not appropriate; radical surgery is often preferable.