It is well established that individuals with psychiatric disorders have a higher mortality rate. Chronic physical disorders account for much of this excess mortality. Take the example of cancer: Cancer incidence among our patients is similar to general population, but they have higher mortality from cancers.This disparity ( between incidence and mortality) is very prominent for prostate and colorectal cancers. Why do this happen? …delayed diagnosis? … lack of access to screening?… reduced access to treatment?…not receiving appropriate treatment?…Research show that marginalised groups may not have easy access to screening or diagnostic services .Inequities are also observed in treatments offered to them.
Studies show that people with severe mental illness, including depression, are less likely to receive routine cancer screening.But there is little information on access to specialist services following diagnosis.
Stephen Kisely, Elizabeth Crowe and David Lawren from Australia investigated whether the increased mortality from cancer in psychiatric patients was associated with later presentation using administrative data from a geographically defined population of people with mental illness and compared them with those in the general population. (ie a Population-based record-linkage analysis).
The project identified all psychiatric patients in Western Australia who presented with cancer . Their outcomes were compared with those of the general population through the calculation of age- and sex- standardized rates, which were then adjusted for confounders using multivariate analyses.
Overall cancer incidence was lower for psychiatric patients than for the general population in both males and females. The age-standardized incidence rate for cancer in psychiatric patients was 368 per 100 000 person-years compared with 417 per 100 000 person-years in the general population. Incidence in psychiatric patients was higher only for lung cancers ( among both males and females) as well as those of unknown primary site in males.
Among psychiatric patients those with alcohol or drug disorders had elevated ‘all-site cancer’ rates. Higher rates were seen in both male and female patients with ‘other psychoses’. Incidence of cancer was lower in patients with dementia and schizophrenia. No significant association was seen between cancer incidence and socioeconomic status.
The proportion of patients with cancer who had metastases at presentation was significantly higher in psychiatric patients .Psychiatric patients had a reduced likelihood of surgical treatments .They also received significantly fewer chemotherapy sessions. There was no difference in the proportion receiving radiotherapy between psychiatric patients and the general population.
Conclusions: Psychiatric patients in this study have lesser incidence of cancers. However, they are more likely to have metastases at diagnosis and less likely to receive specialized interventions.
Comments: It has been shown previously that psychiatric patients are less likely to get same care for physical disorders as general population. For example, they are less likely to have their weight or blood pressure measured in primary care. Same problems are observed in serious life limiting disorders as well.
Cancer-related mortality in people with mental illness. Kisely S, Crowe E, Lawrence D.JAMA Psychiatry. 2013 Feb;70(2):209-17.