Abstract
ObjectivesTo 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.DesignPopulation-based retrospective cohort study using linked cancer registry and administrative data at ICES.SettingThe universal healthcare system in Ontario, Canada.ParticipantsColorectal 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 measuresCancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation.Results24,507 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.ConclusionsIndividuals 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.
Highlights
The association between a severe psychiatric illness (SPI) and worse cancer survival has received less attention than other physical diseases, physical illness is the leading cause of death among people with mental health disorders [1]
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
A small amount of research has been performed to understand if individuals with an SPI are more likely to receive suboptimal oncology care [12, 14, 23,24,25,26,27,28,29,30,31], or investigated specific barriers to providing cancer care to individuals with a serious mental illness [32]
Summary
The association between a severe psychiatric illness (SPI) and worse cancer survival has received less attention than other physical diseases, physical illness is the leading cause of death among people with mental health disorders [1]. A small amount of research has been performed to understand if individuals with an SPI are more likely to receive suboptimal oncology care [12, 14, 23,24,25,26,27,28,29,30,31], or investigated specific barriers to providing cancer care to individuals with a serious mental illness [32]. These studies consistently document the suboptimal cancer treatment of individuals with an SPI and cancer. Few have investigated treatment for a single cancer site within the context of clinical guidelines [23,24,25, 30], which limits the interpretation and application of the study results to clinical practice
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
