Psych Patients Shortchanged on Cancer Tx (CME/CE)

FG_AUTHORS: MedPage Today

Psychiatric patients with a cancer diagnosis were more likely to have metastases and less likely to receive specialized cancer treatments compared with the general population, researchers found.

Based on an analysis of data from several Australian health registries, a greater proportion of psychiatric patients presented with metastases at diagnosis compared with cancer patients without psychiatric illness (7.1%, 95% CI 6.5% to 7.8% versus 6.1%, 95% CI 6.0% to 6.2%), according to Stephen Kisely, PhD, of the University of Queensland in Australia, and colleagues.

Psychiatric patients also had a reduced likelihood of receiving surgical treatment (hazard ratio 0.81, 95% CI 0.76 to 0.86), including resection of colorectal, breast, and cervical cancers and radiotherapy for breast, colorectal, and uterine cancers, they wrote online in the Archives of General Psychiatry.

The authors noted that the incidence of cancer was not higher in psychiatric patients than among the general population, adding that the greater incidence of metastases at diagnosis and lower incidence of specialized treatment "may explain the greater case fatality found in people with psychiatric disorder."

Kisely and colleagues looked at potential mechanisms for the higher rate of mortality among patients with a psychiatric disorder than among the general population despite similar rates of cancer development between the two patient populations.

They compared record data of 6,586 psychiatric patients with a cancer diagnosis in Western Australia, with matched data from the general population, between 1988 and 2007. The researchers analyzed cancer metastases, incidence, mortality, and access to treatments.

Psychiatric disorders were validated by the International Classification of Diseases, Ninth Revision and Tenth Revision.

Patients with cancer and a psychiatric disorder were slightly older than the general population (mean age 64.3 versus 63.2), and the majority were female (53.2%). Cancer incidence was also lower overall among patients with a psychiatric disorder than in the general population (rate ratio 0.88, 95% CI 0.85 to 0.91).

Cancer risks were reduced in patients with dementia (HR 0.72, 95% CI 0.62 to 0.83) and schizophrenia (HR 0.80, 95% CI 0.67 to 0.95), and elevated in those with depression (HR 1.20, 95% CI 1.05 to 1.38), neurotic disorder (HR 1.20, 95% CI 1.04 to 1.38), and alcohol or drug disorders (HR 1.26, 95% CI 1.08 to 1.46).

Psychiatric patients had a 20% higher rate of cancer mortality overall. They also had higher rates of site-specific cancer morality, namely:

  • Gynecological: RR 1.26 (95% CI 1.01 to 1.58)
  • Prostate: RR 1.51 (95% CI 1.25 to 1.83)
  • Male urological: RR 1.38 (95% CI 1.06 to 1.80)
  • Female colorectal: RR 1.54 (95% CI 1.30 to 1.82)
  • Female melanoma: RR 1.47 (95% CI 1.01 to 2.14)
  • Male unknown primary site cancers: RR 1.49 (95% CI 1.30 to 1.82)

Compared with the general population, psychiatric patients were significantly more likely to present with metastases at diagnosis, were significantly less likely to received surgical treatment, and received significantly fewer chemotherapy sessions (mean 10.3 sessions versus 12.1).

Overall, there was no difference in the proportion of patients who received radiotherapy between psychiatric patients and the general population. However, cancer-specific proportions of radiotherapy were significantly lower for those with breast, colorectal, and uterine cancers (P<0.05).

"These results could suggest inequitable access to appropriate care, especially given that reduced access to treatment persisted after controlling for the presence of metastases," the authors concluded.

The study was limited by a lack of information on the medications the psychiatric patients were taking along with a lack of data on ethnicity, marital status, education level, comorbidity, lifestyle characteristics, and disability. The cancer registry used in this study does not contain information on staging other than the presence or absence of metastases. Finally, administrative data may be subject to recording bias.

The study was funded by a grant from the Griffith Institute for Health and Medical Research.

The authors declared no conflicts of interest.

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