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Leonard S, Helstrom E, Correa A, Sindhani M, Uzzo N, Jia AY, Kutikov A, Uzzo R, Psutka SP, Calaway A, Klaassen Z, Staehler M, Smaldone M, Wallis CJD, Bukavina L. Financial Distress in Genitourinary Cancer: Insights From CDC National Health Interview Survey. JCO Oncol Pract 2024:OP2300733. [PMID: 39008789 DOI: 10.1200/op.23.00733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/27/2024] [Accepted: 04/25/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE This study leverages CDC National Health Interview Survey data to examine Financial Distress (FD) among genitourinary (GU) cancer survivors, specifically prostate cancer (PC), kidney cancer (KC), and bladder cancer (BC). It investigates the economic impacts faced by these patients, especially in relation to disparities in insurance coverage and its effects on material, psychological, and behavioral aspects of FD. METHODS We retrospectively analyzed responses from GU cancer survivors, stratifying by cancer status and age (18-64 years, ≥65 years). Medical financial hardship was divided into three domains: material, psychological, and behavioral. Associations between cancer history, hardship, and clinical factors were assessed using generalized ordinal logistic regressions. RESULTS Significant health care access disparities were found, particularly for mental health services, with 25% of younger BC survivors and 4.7% of younger KC survivors reporting affordability issues, in contrast to 2.7% of noncancer individuals. Dental care was also problematic, with higher avoidance rates among younger BC (27%) and KC (15%) survivors compared with the general population. Surprisingly, noncancer individuals reported more difficulty in affording prescriptions than BC survivors across both age groups. PC survivors, however, showed lower FD across all domains versus noncancer controls, indicating fewer concerns about medical bills and a lesser tendency to forgo care. CONCLUSION The study underscores significant gaps in the financial support system for GU cancer survivors, with urgent needs in mental and dental health care access. Policy interventions, including comprehensive insurance reforms, are imperative to alleviate the financial burdens on these individuals.
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Affiliation(s)
| | | | | | - Mohit Sindhani
- India Institute of Technology, Delhi, India
- Case Western Reserve School of Medicine, Cleveland, OH
| | | | - Angela Y Jia
- Case Western Reserve School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | - Sarah P Psutka
- University of Washington Medical Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Adam Calaway
- Case Western Reserve School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA
| | | | | | | | - Laura Bukavina
- Case Western Reserve School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Cleveland Clinic Glickman Urologic Institute, Cleveland, OH
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Cunningham R, Stanley J, Imlach F, Haitana T, Lockett H, Every-Palmer S, Clark MTR, Lacey C, Telfer K, Peterson D. Cancer diagnosis after emergency presentations in people with mental health and substance use conditions: a national cohort study. BMC Cancer 2024; 24:546. [PMID: 38689242 PMCID: PMC11062004 DOI: 10.1186/s12885-024-12292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Cancer survival and mortality outcomes for people with mental health and substance use conditions (MHSUC) are worse than for people without MHSUC, which may be partly explained by poorer access to timely and appropriate healthcare, from screening and diagnosis through to treatment and follow-up. Access and quality of healthcare can be evaluated by comparing the proportion of people who receive a cancer diagnosis following an acute or emergency hospital admission (emergency presentation) across different population groups: those diagnosed with cancer following an emergency presentation have lower survival. METHODS National mental health service use datasets (2002-2018) were linked to national cancer registry and hospitalisation data (2006-2018), to create a study population of people aged 15 years and older with one of four cancer diagnoses: lung, prostate, breast and colorectal. The exposure group included people with a history of mental health/addiction service contact within the five years before cancer diagnosis, with a subgroup of people with a diagnosis of bipolar disorder, schizophrenia or psychotic disorders. Marginal standardised rates were used to compare emergency presentations (hospital admission within 30 days of cancer diagnosis) in the exposure and comparison groups, adjusted for age, gender (for lung and colorectal cancers), ethnicity, area deprivation and stage at diagnosis. RESULTS For all four cancers, the rates of emergency presentation in the fully adjusted models were significantly higher in people with a history of mental health/addiction service use than people without (lung cancer, RR 1.19, 95% CI 1.13, 1.24; prostate cancer RR 1.69, 95% CI 1.44, 1.93; breast cancer RR 1.42, 95% CI 1.14, 1.69; colorectal cancer 1.31, 95% CI 1.22, 1.39). Rates were substantially higher in those with a diagnosis of schizophrenia, bipolar disorder or psychotic disorders. CONCLUSIONS Implementing pathways for earlier detection and diagnosis of cancers in people with MHSUC could reduce the rates of emergency presentation, with improved cancer survival outcomes. All health services, including cancer screening programmes, primary and secondary care, have a responsibility to ensure equitable access to healthcare for people with MHSUC.
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Mkuu R, Salloum RG, Shenkman E, Schaefer N, Le T, Jorratt A, Meduri Y, Goede D, Lee JH, Staras SA. Screening for cervical cancer among women with behavioral health conditions-A systematic review. Prev Med Rep 2023; 34:102238. [PMID: 37273521 PMCID: PMC10236291 DOI: 10.1016/j.pmedr.2023.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Cervical cancer screening is credited with dramatically reducing cervical cancer mortality in the United States. There is a lack of consensus on whether women with behavioral health conditions (mental health or substance use) receive cervical cancer screening at rates similar to women without the conditions. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched for articles and abstracts of conference proceedings in PubMed, EMBASE, Web of Science and the EBSCO databases: CINAHL, PsycINFO, Psychosocial and Behavioral Science Collection, Academic Search Premier Databases, and the ProQuest database Applied Social Sciences Index and Abstracts from January 1, 2000 to July 31, 2020. Eligibility criteria included studies conducted in the United States, published in English, and comparing cervical cancer screening rates of women with and without behavioral health conditions. Of 1,242 unique articles screened, 52 were included in the full text review. And after title/abstract/and full-text review, 14 articles met the eligibility criteria. Six studies examined both mental health and substance use conditions, two studies only examined substance use disorders, and six studies examined only mental health conditions. Substance use disorders were associated with a decreased likelihood of receiving screening. This study yeilded inconclusive findings on the relationship between mental health conditions and cervical cancer screening. More research is needed to better understand the relationship between behavioral health conditions and cervical cancer screening.
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Affiliation(s)
- Rahma Mkuu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
- Department of Health Science, University of Alabama, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida Communicore Building, SW Archer Rd, Gainesville, FL 32610, United States
| | - Tran Le
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Andrea Jorratt
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Yashaswini Meduri
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Dianne Goede
- Internal Medicine, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4th Floor, Suite 4592, Gainesville, FL 32610-3008, United States
| | - Ji-Hyun Lee
- Division of Quantitative Sciences at the University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Stephanie A.S. Staras
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
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Eseadi C, Ngwu MO. Significance of music therapy in treating depression and anxiety disorders among people with cancer. World J Clin Oncol 2023; 14:69-80. [PMID: 36908676 PMCID: PMC9993142 DOI: 10.5306/wjco.v14.i2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
Globally, cancer cases and mortality have recently escalated and have attracted global concern. The clinical diagnosis and manifestation of cancer can result in significant mental health issues like depression and anxiety disorders. The tendency of people with cancer to suffer from psychological disorders such as anxiety and depression is usually high. A significant number of deaths related to cancer may likely not be from the killer disease but from psychological disorders associated with the illness. The utilization of music as a remedial approach to healing mental disorders cannot be overstated. Thus, identifying the impacts of music therapy in dealing with depression and anxiety disorders among people with cancer is relevant, as the majority of methods used in treating cancer have some side effects which may trigger psychological disorders in cancer patients. Ultimately, this study explored the significance of music therapy in treating depression and anxiety disorders among people with cancer. To achieve the aim of this study, the authors employed a narrative literature review to investigate the significance of music therapy in addressing depression and anxiety disorders among people with cancer. The type of literature review employed in this study is to provide an understanding of the selected research papers. The review found that music therapy significantly reduces depression and anxiety disorders among breast cancer, lung cancer, prostate cancer, and colorectal cancer patients. It is needful for healthcare providers to incorporate music therapy interventions while treating people with cancer. This will help reduce cancer deaths resulting from psychological disorders rather than the killer disease, cancer. However, the standardized procedures and evaluation criteria for applying music-based intervention strategies in oncology medicine still need to be further established and improved.
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Affiliation(s)
- Chiedu Eseadi
- Department of Educational Psychology, University of Johannesburg, Gauteng 2006, South Africa
| | - Millicent O Ngwu
- Department of Sociology and Anthropology, University of Nigeria, Nsukka 41001, Enugu, Nigeria
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Arvanitou E, Nikoloudi M, Tsoukalas N, Parpa E, Mystakidou K. Factors associated with anxiety and depression in cancer patients: Demographic factors and the role of demoralization and satisfaction with care. Psychooncology 2023; 32:712-720. [PMID: 36797821 DOI: 10.1002/pon.6115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Anxiety and depression are common in cancer patients and seem to affect quality of life, treatment compliance and even survival. Defining factors related to anxiety and depression and exploring the role of demoralization and satisfaction with care, could contribute to the improvement of patients' quality of life and quality of health services as well. METHODS A convenience sample of 150 cancer inpatients and outpatients from two oncology centers, with various types of solid tumors, participated in a prospective cross-sectional observational study. The psychometric tools used were the Greek versions of the Hospital Anxiety and Depression Scale, FAMCARE-Patient Scale and Oncology Palliative Care (FAMCARESCALE) and Demoralization Scale (DEMORALIZATION SCALE II, DS-II). RESULTS Patients mean age was 62 years (20-85 years) and 89 patients (59.3%) were women. Among patients, 33% had breast, 24% gastrointestinal and 15% lung cancer. Eighty-two patients (54.7%) had metastatic disease. Women showed higher rates of anxiety (p = 0.054). Anxiety was inversely related to age (p = 0.043) and positively correlated with time since diagnosis (p = 0.076). Unmarried patients presented with higher rates of depression (p = 0.026). Multiple linear regression showed a statistically significant impact of Demoralization factor 'Meaning and Purpose' on anxiety (p < 0.001, R2 = 36.3%) and depression (p < 0.001, R2 = 49%). Moreover, higher educational level (p = 0.038, R2 = 3.1%) is related to higher levels of anxiety and higher scores of FAMCARESCALE factor-Information/interaction with the health care professionals, is related to lower levels of depression (p = 0.008, R2 = 2.7%). CONCLUSIONS The results highlight the significant impact of demoralization on anxiety and depression in cancer patients. Early recognition of demoralization and early referral to mental health professionals will hopefully alleviate the mental burden of cancer patients.
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Affiliation(s)
- Eleni Arvanitou
- Oncology Clinic, 401 General Military Hospital, Athens, Greece
| | - Maria Nikoloudi
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efi Parpa
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Mystakidou
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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An Evaluation of the Impact of Mental Illness on Postoperative Breast Reconstruction Revision Surgery. Plast Reconstr Surg Glob Open 2023; 11:e4739. [PMID: 36699222 PMCID: PMC9820774 DOI: 10.1097/gox.0000000000004739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023]
Abstract
Breast cancer impacts millions of people yearly affecting various aspects of their lives-including but not limited to mental health. Patients with a known psychiatric history, specifically generalized anxiety disorder (GAD) and/or depression, have previously been shown to have an increased number of revisions after breast reconstruction. Methods A commercially available database of 91 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent autologous free flap breast reconstruction. An average number of revisions were calculated from each group of patients-those with a history of anxiety and/or depression and patients without a history of anxiety and/or depression. A logistic regression was performed to determine risk factors associated with patients undergoing revision surgery. Results A total of 39,683 patients with a history of breast cancer underwent autologous breast reconstruction between 2010 and 2020, of which 6308 (15.9%) patients had a history of GAD and/or depression before autologous reconstruction. A total of 13,422 (33.8%) patients received at least one revision surgery. Patients with GAD only, depression only, and concomitant GAD and depression received 1.40 revisions each with no significant differences between the control and any of the study groups (P = 0.956). Logistic regression did not find psychiatric history to be associated with patients undergoing revision surgery (OR, 0.94; 95% CI, 0.89-1.00). Conclusion Patients who underwent autologous reconstruction for breast cancer demonstrated no difference in rates of secondary surgical revision, regardless of a concurrent mental health history.
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Kirkøen B, Berstad P, Hoff G, Bernklev T, Randel KR, Holme Ø, de Lange T, Robb KA, Botteri E. Type and Severity of Mental Illness and Participation in Colorectal Cancer Screening. Am J Prev Med 2023; 64:76-85. [PMID: 36216655 DOI: 10.1016/j.amepre.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation. METHODS Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships. RESULTS Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests. CONCLUSIONS These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.
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Affiliation(s)
- Benedicte Kirkøen
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway.
| | - Paula Berstad
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Geir Hoff
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Skien, Norway; Institute of Clinical Medicine, University of Oslo Oslo, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo Oslo, Norway; Department of Research and Development, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kristin R Randel
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Øyvind Holme
- Department of medicine, Sørlandet Hospital, Kristiansand, Norway; Institute of Health & Society, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Sahlgrenska University Hospital-Mölndal, Region Västra Götaland, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Research, Bærum Hospital, Gjettum, Norway
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Edoardo Botteri
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; and the Department of Research, Cancer Registry of Norway, Oslo, Norway
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Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel) 2022; 10:healthcare10122366. [PMID: 36553890 PMCID: PMC9777663 DOI: 10.3390/healthcare10122366] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Schizophrenia is a life-shortening disease and life expectancy in patients may be 15-20 years shorter than in the general population, with increasing longevity gap over time. Premature mortality in schizophrenia-spectrum disorders is mainly due to preventable natural causes, such as cardio-vascular disease, infections, respiratory tract diseases and cancer, alongside suicide, homicide and accidents. There is a complex interplay of factors that act synergistically and cause physical morbidity to patients and subsequent mortality. Smoking, alcohol/substance abuse and sedentary life style, alongside disease-related factors, such as metabolic abnormalities and accelerating aging contribute to physical morbidity. Moreover, the symptomatology of psychosis and stigma may limit patients' access to quality medical care. Interventions to promote physical health in those patients should be multifaceted, and should target all patient-related modifiable factors, but also should address service-related healthcare disparities. Long-term antipsychotic use (including clozapine and long-acting injectables) is associated with substantially decreased all-cause mortality, including suicide and cardiovascular mortality, in patients with schizophrenia despite the well-known cardiometabolic adverse effects of second-generation agents. Integrated care may involve co-location of physical and mental health services, liaison services, shared protocols and information sharing systems, and has emerged as a way to address the physical health needs of those patients. Interventions to address mortality in schizophrenia and related syndromes should take place as early as possible in the course of the patients' treatment, and could be an integral component of care delivered by specialized early intervention services.
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Hu S, Baraghoshi D, Chang C, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Smith K, Peoples AR, Gaffney D, Hashibe M. Mental health disorders among ovarian cancer survivors in a population-based cohort. Cancer Med 2022; 12:1801-1812. [PMID: 35773781 PMCID: PMC9883396 DOI: 10.1002/cam4.4976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ovarian cancer is the fifth most common female cancer in the United States. There have been very few studies investigating mental health diagnoses among ovarian cancer survivors with long-term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. PATIENTS AND METHODS Cohorts of 1689 ovarian cancer patients diagnosed between 1996 and 2012 and 7038 women without cancer matched by age and birth state from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). RESULTS Ovarian cancer survivors experienced increased risks of mental illnesses within the first 2 years after cancer diagnosis (HR = 3.55, 95% CI = 3.04-4.14). The risks of depression among ovarian cancer survivors were nearly 3-fold within the first 2 years of cancer diagnosis (HR = 2.59, 95% CI = 1.94-3.47), and 1.69-fold at 2-5 years after cancer diagnosis (HR = 1.69, 95% CI = 1.18-2.42). Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR = 1.80, 95% CI = 1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR = 1.94, 95% CI = 1.56-2.40). CONCLUSIONS Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors.
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Affiliation(s)
- Siqi Hu
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - David Baraghoshi
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Chun‐Pin Chang
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Kerry Rowe
- Intermountain HealthcareSalt Lake CityUtahUSA
| | - John Snyder
- Intermountain HealthcareSalt Lake CityUtahUSA
| | | | - Michael Newman
- University of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Alison Fraser
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Pedigree and Population Resource, Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Ken Smith
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Pedigree and Population Resource, Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Anita R. Peoples
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Department of Radiation OncologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - David Gaffney
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Department of Population Health SciencesUniversity of Utah School of MedicineSalt Lake CityUtahUSA,Department of Radiation OncologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Mia Hashibe
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
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Chang WH, Lai AG. Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers. Nat Med 2022; 28:860-870. [PMID: 35347280 PMCID: PMC9018408 DOI: 10.1038/s41591-022-01740-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Cancer is a life-altering event causing considerable psychological distress. However, information on the total burden of psychiatric disorders across all common adult cancers and therapy exposures has remained scarce. Here, we estimated the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer and the risk of unnatural deaths after self-harm in 459,542 individuals. Depression was the most common psychiatric disorder in patients with cancer. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders, whereas those treated with kinase inhibitors had the lowest burden. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (hazard ratio (HR), 6.8; 95% confidence interval (CI), 4.3-10.7). The risk of unnatural death after 12 months was markedly lower (HR, 2.0; 95% CI, 1.5-2.7). We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritizing patients who are most at risk.
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Affiliation(s)
- Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK
| | - Alvina G Lai
- Institute of Health Informatics, University College London, London, UK.
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Bos D, Gray R, Meepring S, White J, Foland K, Bressington D. The Health Improvement Profile for people with severe mental illness: Feasibility of a secondary analysis to make international comparisons. J Psychiatr Ment Health Nurs 2022; 29:86-98. [PMID: 33655576 DOI: 10.1111/jpm.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/05/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates. No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: It appears feasible to use the HIP to profile and compare physical health-related risks in people with SMI across different international settings. The HIP tool identified significant differences in areas of risk across the four countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP could be used to identify unique clusters of health promotion needs in different countries. Use of HIP health checks may support implementation of individualized interventions. ABSTRACT: Introduction To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi-national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources.
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Affiliation(s)
- Dawn Bos
- School of Nursing, Winona State University, Rochester, MN, USA
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | | | - Jacquie White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Kay Foland
- School of Nursing, South Dakota State University, Brookings, SD, USA
| | - Daniel Bressington
- College of Nursing & Midwifery, Charles Darwin University, Darwin, NT, Australia
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12
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Ross E, Maguire A, Mairs A, Hall C, Donnelly MJC, O'Reilly DPJ. Disparities in Breast Cancer Screening Uptake for Women With Mental Illness in the United Kingdom. Am J Prev Med 2021; 60:e123-e130. [PMID: 33358549 DOI: 10.1016/j.amepre.2020.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although there is evidence of disparities in breast cancer screening for women with mental illness in the U.S., there is a dearth of studies examining this association in the United Kingdom, where health care is provided free at the point of access. This population-based study examines the influence of mental illness, as assessed by the uptake of psychotropic medications, on breast screening uptake in the United Kingdom. METHODS A cohort of 57,328 women identified from 2011 Census records within the Northern Ireland Longitudinal Study was followed through a single 3-year screening cycle (2011-2014) of the National Health Service Breast Screening Programme. Mental illness was identified by a receipt of psychotropic medication in the 3 months preceding screening invite. Individual- and household-level attributes were derived from Census records. Data were analyzed in 2019. RESULTS More than a third of women received ≥1 prescription for psychotropic medication in the 3 months preceding screening invite. The odds of attendance in these individuals were reduced by 15% (OR=0.85, 95% CI=0.81, 0.88). Attendance was particularly low for women prescribed antipsychotics (OR=0.63, 95% CI=0.56, 0.70), anxiolytics (OR=0.61, 95% CI=0.57, 0.66), and hypnotics (OR=0.68, 95% CI=0.63, 0.72). CONCLUSIONS These findings confirm the existence of significant disparities in breast screening uptake for women with mental illness. Targeted interventions are warranted to prevent avoidable breast cancer deaths in these individuals, especially given the increasing prevalence of mental illness.
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Affiliation(s)
- Emma Ross
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Adrian Mairs
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Clare Hall
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | - Dermot P J O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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13
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Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer. Soc Sci Med 2021; 270:113643. [PMID: 33387965 PMCID: PMC9989878 DOI: 10.1016/j.socscimed.2020.113643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders. RESULTS Preexisting SMI was associated with greater all-cause (HR = 1.36; 95%CI 1.18, 1.57) and cancer-specific (HR = 1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR = 1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR = 2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR = 1.49; 95%CI 1.25, 1.78), obese (HR = 1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR = 1.42; 95%CI 1.13, 1.78). CONCLUSION Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.
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14
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Berchuck JE, Meyer CS, Zhang N, Berchuck CM, Trivedi NN, Cohen B, Wang S. Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non-Small Cell Lung Cancer. JAMA Oncol 2021; 6:1055-1062. [PMID: 32496507 DOI: 10.1001/jamaoncol.2020.1466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Preexisting mental health disorders (MHDs) are associated with increased mortality in people diagnosed with cancer, yet few data exist on the efficacy of interventions to mitigate this disparity. Objective To evaluate the association of participation in mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among patients with a preexisting MHD. Design, Setting, and Participants This retrospective, population-based cohort study included 55 315 veterans in the Veterans Affairs Central Cancer Registry (VACCR) who had newly diagnosed non-small cell lung cancer (NSCLC) from September 30, 2000, to December 31, 2011. Data were analyzed from January 15, 2017, to March 17, 2020. Exposures Mental health disorders, including schizophrenia, bipolar disorder, depressive disorder, posttraumatic stress disorder, and substance use disorder. Main Outcomes and Measures Stage at cancer diagnosis, receipt of stage-appropriate cancer treatment, all-cause mortality, and lung cancer-specific mortality. Results Of 55 315 veterans with a new diagnosis of NSCLC included in the analysis (98.1% men; mean [SD] age, 68.1 [9.8] years), 18 229 had a preexisting MHD, among whom participation in MHTPs was associated with a lower likelihood of being diagnosed in a late stage (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), a higher likelihood of receiving stage-appropriate treatment (OR, 1.55; 95% CI, 1.26-1.89; P < .001), lower all-cause mortality (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.72-0.77; P < .001), and lower lung cancer-specific mortality (AHR, 0.77; 95% CI, 0.74-0.80; P < .001). Likewise, participation in housing and employment support programs was associated with similar improvements in all outcomes described above. Conclusions and Relevance In veterans with preexisting MHDs diagnosed with NSCLC, participation in MHTPs and housing and employment support programs was associated with improved lung cancer-related outcomes. This study might be the first to demonstrate significant improvement in cancer mortality for patients with MHDs who participate in MHTPs, housing support programs, or employment support programs. This work supports substantial literature that investment in mental health and social needs can improve health outcomes and highlights the importance of further research to identify, evaluate, and implement interventions to improve outcomes for patients with MHDs who are diagnosed with cancer.
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Affiliation(s)
- Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Craig S Meyer
- Department of Medicine, School of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, School of Medicine, University of California, San Francisco
| | | | - Neil N Trivedi
- Division of Pulmonary/Critical Care Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
| | - Beth Cohen
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sunny Wang
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Division of Hematology/Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, California
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15
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Cunningham R, Stanley J, Haitana T, Pitama S, Crowe M, Mulder R, Porter R, Lacey C. The physical health of Māori with bipolar disorder. Aust N Z J Psychiatry 2020; 54:1107-1114. [PMID: 32929981 DOI: 10.1177/0004867420954290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. METHODS A cohort of Māori and non-Māori with a current bipolar disorder diagnosis at 1 January 2010 were identified from routine mental health services data and followed up for non-psychiatric hospital admissions and deaths over the subsequent 5 years. RESULTS Māori with bipolar disorder had a higher level of morbidity and a higher risk of death from natural causes compared to non-Māori with the same diagnosis, indicating higher levels of physical health need. The rate of medical and surgical hospitalisation was not higher among Māori compared to non-Māori (as might be expected given increased health needs) which suggests under-treatment of physical health conditions in this group may be a factor in the observed higher risk of mortality from natural causes for Māori. CONCLUSION This study provides the first indication that systemic factors which cause health inequities between Māori and non-Māori are compounded for Māori living with severe mental illness. Further exploration of other diagnostic groups and subgroups is needed to understand the best approach to reducing these inequalities.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tracy Haitana
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
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16
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Mahar AL, Kurdyak P, Hanna TP, Coburn NG, Groome PA. The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study. PLoS One 2020; 15:e0235409. [PMID: 32726314 PMCID: PMC7390537 DOI: 10.1371/journal.pone.0235409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To 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. DESIGN Population-based retrospective cohort study using linked cancer registry and administrative data at ICES. SETTING The universal healthcare system in Ontario, Canada. PARTICIPANTS Colorectal 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 MEASURES Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation. RESULTS 24,507 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. CONCLUSIONS Individuals 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.
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Affiliation(s)
- Alyson L. Mahar
- Department of Community Health Sciences, Manitoba Centre for Health Policy University of Manitoba, Winnipeg, Manitoba, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- ICES, Toronto, Ontario, Canada
- Division of Cancer Care and Epidemiology, Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Natalie G. Coburn
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patti A. Groome
- ICES, Toronto, Ontario, Canada
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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17
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Ni L, Wu J, Long Y, Tao J, Xu J, Yuan X, Yu N, Wu R, Zhang Y. Mortality of site-specific cancer in patients with schizophrenia: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:323. [PMID: 31660909 PMCID: PMC6816203 DOI: 10.1186/s12888-019-2332-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Numerous studies have reported contradicting results on the relationship between cancer mortality and schizophrenia. Our aim is to quantify the mortality rate of common site-specific cancers among patients with schizophrenia and to synthesize the available research evidence. METHODS We performed a systemic search of the PubMed, EMBASE and Web of Science databases. Studies reporting the mortality rate of different cancer in patients with schizophrenia were included. A random-effects model was applied to calculate the pooled relative risks (RRs) with 95% confidence intervals (95%CIs). RESULTS Seven studies consisting of 1,162,971 participants with schizophrenia were included in this meta-analysis. Data regarding mortality risk of breast, colon, lung and prostate cancer among schizophrenia patients were subjected to quantitative analysis. Pooled results showed significant increases in mortality risk of breast cancer (RR = 1.97, 95%CI 1.38-2.83), lung cancer (RR = 1.93, 95%CI 1.46-2.54) and colon cancer (RR = 1.69, 95%CI 1.60-1.80) in patients with schizophrenia compared with those in the general population or control group. The mortality risk of prostate cancer increased in male patients, although no significant difference was detected (RR = 1.58, 95% CI 0.79-3.15). Increased risks of mortality from lung and colon cancer were observed in female patients (RR = 2.49, 95%CI 2.40-2.59 and RR = 2.42, 95%CI 1.39-4.22, respectively) and elevated risks of mortality from lung and colon cancer in male patients (RR = 2.40, 95%CI 2.30-2.50 and RR = 1.90, 95%CI 1.71-2.11, respectively) were detected. CONCLUSIONS Individuals with schizophrenia have a significantly high risk of mortality from breast, colon, and lung cancer.
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Affiliation(s)
- Liwei Ni
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jian Wu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Yuming Long
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jialong Tao
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jianhao Xu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Xuya Yuan
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Na Yu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Runhong Wu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Yusong Zhang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
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18
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Davis LE, Bogner E, Coburn NG, Hanna TP, Kurdyak P, Groome PA, Mahar AL. Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis. J Epidemiol Community Health 2019; 74:84-94. [PMID: 31653661 DOI: 10.1136/jech-2019-212311] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/27/2019] [Accepted: 10/06/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. METHODS We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. RESULTS 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. DISCUSSION This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.
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Affiliation(s)
- Laura E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Emma Bogner
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care & Epidemiology & Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology and Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alyson L Mahar
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada .,Department of Community Health Sciences, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
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19
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Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer 2019; 19:943. [PMID: 31604468 PMCID: PMC6788022 DOI: 10.1186/s12885-019-6181-4] [Citation(s) in RCA: 318] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety. We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited. Conclusion Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.
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Affiliation(s)
- Claire L Niedzwiedz
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
| | - Lee Knifton
- University of Strathclyde, Centre for Health Policy, Glasgow, Scotland, UK.,Mental Health Foundation, Glasgow, Scotland, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Daniel J Smith
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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20
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The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990–2013: a register-based cohort study. Eur J Cancer 2019; 118:105-111. [DOI: 10.1016/j.ejca.2019.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022]
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21
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Lee Y, Lin PY, Lin MC, Wang CC, Lu HI, Chen YC, Chong MY, Hung CF. Morbidity and associated factors of depressive disorder in patients with lung cancer. Cancer Manag Res 2019; 11:7587-7596. [PMID: 31496813 PMCID: PMC6691945 DOI: 10.2147/cmar.s188926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/21/2019] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to assess morbidity and associated factors in patients with lung cancer (LC). Methods This study used a cross-sectional design with consecutive sampling. Study subjects were recruited from the LC outpatient clinic and inpatient ward in a medical center from March 2016 to February 2018. Patients with LC were enrolled and assessed using the Mini International Neuropsychiatric Interview, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Fatigue Inventory, Numeric Pain Rating Scale, and the List of Threatening Experiences Questionnaire. Results One hundred and four patients were included in the study. The most prevalent psychiatric disorder was depressive disorder (25.0%), followed by adjustment disorder (17.3%), alcohol use disorder (3.8%), and insomnia disorder (3.8%). Fifty percent of patients had a psychiatric diagnosis. Using logistic regression analysis, it was found that severity of fatigue (OR=1.77; 95% CI, 1.03–3.03; p<0.05), severity of stressor (OR=14.14; 95% CI, 2.49–80.20; p<0.05), and severity of anxiety (OR=3.75; 95% CI, 1.87–7.54; p<0.001) were three significant associated factors. Patient health problems, death of a close family member or friend, and major financial crisis were the three most common stressors among our cancer patients. Conclusion Use of a standardized structured interview for early diagnosis and treatment of cancer patients with depressive disorder is crucial and might increase their quality of life.
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Affiliation(s)
- Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Cardiothoracic Vascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Mian-Yoon Chong
- Chang Gung Memorial Hospital, Chiayi, and Chang Gung University School of Medicine, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
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22
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Tamauchi S, Kajiyama H, Moriyama Y, Yoshihara M, Ikeda Y, Yoshikawa N, Nishino K, Niimi K, Suzuki S, Kikkawa F. Relationship between preexisting mental disorders and prognosis of gynecologic cancers: A case-control study. J Obstet Gynaecol Res 2019; 45:2082-2087. [PMID: 31321830 DOI: 10.1111/jog.14053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022]
Abstract
AIM Cancer treatment involves long-term therapy and follow-up, with mental disorders (MD) often affecting the treatment process. Hence, in this study, we retrospectively analyze cases involving gynecologic cancer with MD and clarify the relationship between psychosis and cancer prognosis. METHODS Patients with both gynecologic cancer and MD from January 2003 to August 2016 were recruited in this study. Cases were limited to those whose MD had been diagnosed before their cancer. Control patients without MD were also analyzed. Both cases and controls were adjusted for age, cancer type, and cancer stage. RESULTS A total of 54 patients with gynecologic cancer and MD, as well as 108 controls without MD, were included. The median age of the patients was 52 years. Details regarding cancer type were as follows: 11 ovarian cancers, 26 uterine corpus cancers and 17 cervical cancers. Among these, 25 schizophrenia cases, 15 depressive disorders, 4 bipolar disorders and 10 other MD were recorded. No significant differences in the 5-year survival rate were found between patients and controls. In advanced-stage cervical cancer, however, the prognosis was significantly poor given the low rate of initial treatment completion. Moreover, patients with advanced-stage cervical cancer had significantly lower chemotherapy completion rates compared to those with other gynecologic malignancies. CONCLUSION Mental disorders do not affect the prognosis of gynecologic cancers, except for advanced cervical cancer. Accordingly, improving the low rate of initial treatment completion seems to be a focal point for better prognosis in advanced cervical cancer.
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Affiliation(s)
- Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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The impact of depression on adherence to organized and opportunistic breast cancer screening. Eur J Cancer Prev 2019; 29:53-59. [PMID: 30998527 DOI: 10.1097/cej.0000000000000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One in five women will experience depression over her lifetime, and one out of eight will develop breast cancer. We evaluated the effect of depression on adherence to mammography in Switzerland, where opportunistic and organized screening programs coexist. We analyzed data from 3206 women aged 50-69 who participated in the Swiss Health Survey 2012. We compared mammographic rates among women with no to mild versus moderate to severe depressive symptoms. The effect of the type of screening on the odds of undertaking a mammography was calculated using multivariable logistic regression analysis. Women with moderate to severe major depressive symptoms were more likely to have had a mammography in the previous 2 years than their nondepressed or less-depressed counterparts (51 vs. 39.2%, respectively, P = 0.005). In the multivariable analysis, women with no to mild major depression living in cantons with an organized screening program had an adjusted odds ratio of 2.7 (95% confidence interval: 2.30-3.17, P < 0.001) of having had a mammography within the past 24 months compared with those living in the regions with an opportunistic screening. The adjusted odds ratio for women with moderate to severe major depression was 4.21 (95% confidence interval: 2.13-8.33, P < 0.001). In Switzerland. adherence to mammographic screening among women with moderate to severe major depression is higher than among women with no or minimal major depressive symptoms. This increased adherence is even more pronounced in regions with organized screening.
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Klaassen Z, Wallis CJD, Goldberg H, Chandrasekar T, Sayyid RK, Williams SB, Moses KA, Terris MK, Nam RK, Urbach D, Austin PC, Kurdyak P, Kulkarni GS. The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies. Br J Cancer 2019; 120:840-847. [PMID: 30837680 PMCID: PMC6474265 DOI: 10.1038/s41416-019-0390-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/11/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. METHODS All residents of Ontario diagnosed with one of the top 10 malignancies (1997-2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). RESULTS A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04-1.06), PUG 2 h 1.36 (95% CI 1.30-1.42), and PUG 3 h 1.73 (95% CI 1.63-1.84). Increasing PUG score was also associated with worse ACM. CONCLUSIONS Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.
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Affiliation(s)
- Zachary Klaassen
- 0000 0001 2150 066Xgrid.415224.4Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0001 2284 9329grid.410427.4Division of Urology, Medical College of Georgia–Augusta University, Augusta, GA USA
| | - Christopher J. D. Wallis
- 0000 0001 2150 066Xgrid.415224.4Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON Canada
| | - Hanan Goldberg
- 0000 0001 2150 066Xgrid.415224.4Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON Canada
| | - Thenappan Chandrasekar
- 0000 0001 2150 066Xgrid.415224.4Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON Canada
| | - Rashid K. Sayyid
- 0000 0001 2284 9329grid.410427.4Division of Urology, Medical College of Georgia–Augusta University, Augusta, GA USA
| | - Stephen B. Williams
- 0000 0001 1547 9964grid.176731.5Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX USA
| | - Kelvin A. Moses
- 0000 0004 1936 9916grid.412807.8Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Martha K. Terris
- 0000 0001 2284 9329grid.410427.4Division of Urology, Medical College of Georgia–Augusta University, Augusta, GA USA
| | - Robert K. Nam
- 0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0000 9743 1587grid.413104.3Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON Canada ,0000 0000 8849 1617grid.418647.8Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - David Urbach
- 0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0000 8849 1617grid.418647.8Institute for Clinical Evaluative Sciences, Toronto, ON Canada ,0000 0004 0474 0188grid.417199.3Department of Surgery, University of Toronto, Women’s College Hospital, Toronto, ON Canada
| | - Peter C. Austin
- 0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0000 8849 1617grid.418647.8Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - Paul Kurdyak
- 0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0000 8849 1617grid.418647.8Institute for Clinical Evaluative Sciences, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Girish S. Kulkarni
- 0000 0001 2150 066Xgrid.415224.4Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada ,0000 0000 8849 1617grid.418647.8Institute for Clinical Evaluative Sciences, Toronto, ON Canada
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Starace F, Mungai F, Baccari F, Galeazzi GM. Excess mortality in people with mental illness: findings from a Northern Italy psychiatric case register. Soc Psychiatry Psychiatr Epidemiol 2018; 53:249-257. [PMID: 29273912 DOI: 10.1007/s00127-017-1468-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/03/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE People with mental disorders show mortality rates up to 22.2 times higher than that of the general population. In spite of progressive increase in life expectancy observed in the general population, the mortality gap of people suffering from mental health problems has gradually widened. The aim of this paper was to study mortality rates in people suffering from mental illness in a cohort of people (16,981 subjects) in the local mental health register of the province of Modena during the decade 2006-2015. METHODS Standardized Mortality Ratios (SMRs) were calculated to compare the mortality of people with mental disorders to the mortality of people living in the province of Modena and the excess of mortality was studied in relation to the following variables: gender, age group, diagnosis and causes of death. In addition, Poisson regression analysis was performed to study the association between patient characteristics and mortality. RESULTS An overall excess mortality of 80% was found in subjects under the care of mental health services as compared to the reference population (SMR = 1.8, 95% CI 1.7-1.9). Subjects in the 15-44 year group presented the highest SMR (9.2, 95% CI 6.9-11.4). The most prevalent cause of death was cancer (28.1% of deaths). At the Poisson regression, the diagnosis "Substance abuse and dependence" showed the highest relative risk (RR) (4.00). Moreover, being male, single, unemployed and with a lower qualification was associated with higher RRs. CONCLUSIONS Our study confirms that subjects with mental illness have higher SMR. Noteworthy, the overall higher risk of mortality was observed in the younger age group.
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Affiliation(s)
- Fabrizio Starace
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy.
| | - Flavia Baccari
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Gian Maria Galeazzi
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
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26
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Offer and Use of Smoking-Cessation Support by Depression/Anxiety Status: A Cross-Sectional Survey. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Higher levels of anxiety and depression have been found to be associated with greater difficulty in stopping smoking. This raises the question as to whether mood disturbance may be associated with exposure to, and use of, quitting support.Aims: This study examined whether General Practitioner (GP) advice and/or offer of support, or stop-smoking service use differed between smokers reporting or not reporting depression/anxiety.Methods: Data came from the Smoking Toolkit Study. Participants were 1,162 English adults who reported currently smoking or having stopped within the past 12 months, aged 40+ years, surveyed between April and September 2012. Anxiety/depression was assessed by the mood disturbance item of the EuroQol five dimensions questionnaire (EQ-5D). This was compared to recall of GP quit advice and/or support, and stop-smoking aid use adjusting for age, gender, and social grade.Results/Findings: Smokers reporting depression/anxiety were more likely to recall being offered advice and support to stop smoking by their GP (OR = 1.50, 95% C.I. = 1.05–2.13). However, there were no significant differences in use of stop-smoking aids during the past year.Conclusions: Smokers reporting depression/anxiety are more likely to be offered stop-smoking support by their GPs, but this does not appear to translate into stop-smoking aid use, despite high motivation to quit. Given higher nicotine dependence in this group, mental health specific support may need to be offered, and more needs to be done to make this offer of aid attractive.
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27
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Hwong AR, Mangurian C. Improving Breast Cancer Screening and Care for Women With Severe Mental Illness. J Clin Oncol 2017; 35:3996-3998. [PMID: 29095679 DOI: 10.1200/jco.2017.76.0462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alison R Hwong
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
| | - Christina Mangurian
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
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28
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Koroukian SM, Sajatovic M. Increased cancer-specific mortality in individuals developing mental disorders after cancer diagnosis: biomedical factors versus psychosocial support. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:432. [PMID: 29201884 DOI: 10.21037/atm.2017.08.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, University Hospitals of Cleveland, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals of Cleveland, Cleveland, OH, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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29
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Iglay K, Santorelli ML, Hirshfield KM, Williams JM, Rhoads GG, Lin Y, Demissie K. Impact of Preexisting Mental Illness on All-Cause and Breast Cancer-Specific Mortality in Elderly Patients With Breast Cancer. J Clin Oncol 2017; 35:4012-4018. [PMID: 28934000 DOI: 10.1200/jco.2017.73.4947] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Limited data are available on the survival of patients with breast cancer with preexisting mental illness, and elderly women are of special interest because they experience the highest incidence of breast cancer. Therefore, we compared all-cause and breast cancer-specific mortality for elderly patients with breast cancer with and without mental illness. Methods A retrospective cohort study was conducted by using SEER-Medicare data, including 19,028 women ≥ 68 years of age who were diagnosed with stage I to IIIa breast cancer in the United States from 2005 to 2007. Patients were classified as having severe mental illness if an International Classification of Diseases, Ninth Edition, Clinical Modification code for bipolar disorder, schizophrenia, or other psychotic disorder was recorded on at least one inpatient or two outpatient claims during the 3 years before breast cancer diagnosis. Patients were followed for up to 5 years after breast cancer diagnosis to assess survival outcomes, which were then compared with those of patients without mental illness. Results Nearly 3% of patients had preexisting severe mental illness. We observed a two-fold increase in the all-cause mortality hazard between patients with severe mental illness compared with those without mental illness after adjusting for age, income, race, ethnicity, geographic location, and marital status (adjusted hazard ratio, 2.19; 95% CI, 1.84 to 2.60). A 20% increase in breast cancer-specific mortality hazard was observed, but the association was not significant (adjusted hazard ratio, 1.20; 95% CI, 0.82 to 1.74). Patients with severe mental illness were more likely to be diagnosed with advanced breast cancer and aggressive tumor characteristics. They also had increased tobacco use and more comorbidities. Conclusion Patients with severe mental illness may need assistance with coordinating medical services.
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Affiliation(s)
- Kristy Iglay
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Melissa L Santorelli
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Kim M Hirshfield
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jill M Williams
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - George G Rhoads
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Yong Lin
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Kitaw Demissie
- Kristy Iglay, Melissa L. Santorelli, George G. Rhoads, Yong Lin and Kitaw Demissie, Rutgers School of Public Health; Kim M. Hirshfield, Yong Lin, and Kitaw Demissie, Rutgers Cancer Institute of New Jersey; and Kim M. Hirshfield and Jill M. Williams, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
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Lin J, McGlynn KA, Carter CA, Nations JA, Anderson WF, Shriver CD, Zhu K. The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System. Cancer Epidemiol Biomarkers Prev 2016; 25:1564-1571. [PMID: 27566418 PMCID: PMC5777503 DOI: 10.1158/1055-9965.epi-16-0316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed preexisting mental health disorders and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with non-small cell lung cancer (NSCLC) in the U.S. MHS. METHODS The study used data from the linked database from the Department of Defense's Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007. RESULTS Patients with a preexisting mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without [adjusted HR, 1.11; 95% confidence interval (CI), 1.03-1.20]. CONCLUSIONS Poor survival in NSCLC in patients with a preexisting mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment. IMPACT This study contributes to the current understanding that health care access may not be sufficient to explain the poor survival among patients with NSCLC with preexisting mental health disorders. Cancer Epidemiol Biomarkers Prev; 25(12); 1564-71. ©2016 AACR.
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Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Corey A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Joel A Nations
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland
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31
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Keszte J, Danker H, Dietz A, Meister E, Pabst F, Guntinas-Lichius O, Oeken J, Singer S, Meyer A. Course of psychiatric comorbidity and utilization of mental health care after laryngeal cancer: a prospective cohort study. Eur Arch Otorhinolaryngol 2016; 274:1591-1599. [PMID: 27744529 DOI: 10.1007/s00405-016-4340-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11 % (1 w), 15 % (3 m) and 14 % (12 m), respectively, of which 4 % (12 m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15 % emerging and 6 % chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65 years (p = 0.026), female (p = 0.045) and experienced more often a need for psychological counseling (p ≤ 0.001). One year after surgery, 27 % of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3 % (1 w), 3 % (3 m) and 8 % (12 m), respectively. Only one of these patients received psychological treatment, while 14 % expressed a need for psychological counseling and 7 % for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.
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Affiliation(s)
- J Keszte
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany.
| | - H Danker
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany
| | - A Dietz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Leipzig, Germany
| | - E Meister
- Department of Otorhinolaryngology, Clinical Center Sankt Georg, Leipzig, Germany
| | - F Pabst
- Department of Otorhinolaryngology, Clinical Center Dresden-Friedrichstadt, Dresden, Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Jena, Germany
| | - J Oeken
- Department of Otorhinolaryngology, Clinical Center Chemnitz, Chemnitz, Germany
| | - S Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - A Meyer
- Division Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center, Leipzig, Germany
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Wadia RJ, Yao X, Deng Y, Li J, Maron S, Connery D, Gunduz-Bruce H, Rose MG. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center. Cancer Med 2015; 4:1365-73. [PMID: 26063243 PMCID: PMC4567021 DOI: 10.1002/cam4.483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 12/03/2022] Open
Abstract
There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.
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Affiliation(s)
- Roxanne J Wadia
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Xiaopan Yao
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Yanhong Deng
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Jia Li
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | | | - Donna Connery
- Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Handan Gunduz-Bruce
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Michal G Rose
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
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Mitchell AJ, Vancampfort D, De Hert M, Stubbs B. Do people with mental illness receive adequate smoking cessation advice? A systematic review and meta-analysis. Gen Hosp Psychiatry 2015; 37:14-23. [PMID: 25510845 DOI: 10.1016/j.genhosppsych.2014.11.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/13/2014] [Accepted: 11/14/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevalence rates of smoking in people with mental illness are high, and premature mortality attributed to tobacco related physical comorbidity is a major concern. We conducted a meta-analysis comparing rates of receipt of smoking cessation advice among people with and without mental illness. METHOD Major electronic databases were searched from inception till August 2014 for studies comparing rates of receipt of smoking cessation advice of people with and without a mental illness. Two independent authors completed methodological appraisal and extracted data. A random-effects meta-analysis was utilized. RESULTS Seven studies of satisfactory methodological quality (n mental illness=68,811, n control=652,847) were included. Overall there was no significant difference in smoking cessation advice rates between those with and without a mental illness [relative risk (RR)=1.02, 95% confidence interval (CI)=0.94-1.11, n=721,658, Q=1421, P<.001]. Subgroup analyses demonstrated people with severe mental illness (SMI) received comparable rates of smoking cessation advice to those without SMI (RR=1.09, 95% CI=0.98-1.2, n=559,122). This remained true for people with schizophrenia (RR=1.09, 95% CI=0.68-1.70) and bipolar disorder (RR=1.14, 95% CI=0.85-1.5). People with non-SMIs were slightly more likely to receive smoking cessation advice (RR=1.16, 95% CI=1.04-1.30, Q=1364, P<.001, n=580,206). CONCLUSIONS People with SMI receive similar smoking cessation advice rates to people without mental illness, while those with non-SMI are slightly more likely to receive smoking cessation advice. While progress has been made, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis.
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Affiliation(s)
- Alex J Mitchell
- Department of Cancer Studies & Molecular Medicine, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - Davy Vancampfort
- Department of Neurosciences, KU Leuven-University of Leuven, UPC KU Leuven Campus Kortenberg, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, KU Leuven-University of Leuven, UPC KU Leuven Campus Kortenberg, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, Southwood Site Avery Hill Road Eltham, London SE9 2UG, UK
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Smith J, Arfons L, Cmolik B, Moye J, Ballard E, Haggstrom D. Development and Implementation of a Veterans' Cancer Survivorship Program. Fed Pract 2015; 32:42S-48S. [PMID: 30766094 PMCID: PMC6375468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The integration of a cancer survivorship program and coordination of care with primary care providers in community settings is essential to address veteran cancer survivors' unique needs and to meet national guidelines.
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Affiliation(s)
- Jennifer Smith
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
| | - Lisa Arfons
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
| | - Brian Cmolik
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
| | - Jennifer Moye
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
| | - Ellen Ballard
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
| | - David Haggstrom
- , and are co-directors of the Transforming and Integrating Medical and Surgical Expertise: Patient-Centered Specialty Care Education Center of Excellence at the Louis Stokes Cleveland VAMC (LSCVAMC) in Ohio. Ms. Smith is also on the clinical faculty at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) and a survivorship nurse practitioner at the LSCVAMC, both in Cleveland, Ohio. Dr. Arfons is also a medical oncologist and the director of Hematology/Oncology at LSCVAMC and assistant professor at the CRWU School of Medicine. Dr. Cmolik is also a cardiothoracic surgeon and chief of surgery at LSCVAMC. is a geriatric staff psychologist at the VA Boston Healthcare System and an associate professor of psychology in the Department of Psychiatry at Harvard Medical School, both in Boston, Massachusetts. was a clinical analyst at the VA Loma Linda Healthcare System (retired). is a primary care physician and health services researcher at the Center for Health Information and Communication, Richard L. Roudebush VAMC, and the Division of General Internal Medicine, Indiana University, both in Indianapolis, Indiana
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Mitchell AJ, Pereira IES, Yadegarfar M, Pepereke S, Mugadza V, Stubbs B. Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. Br J Psychiatry 2014; 205:428-35. [PMID: 25452600 DOI: 10.1192/bjp.bp.114.147629] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening. AIMS To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health. METHOD Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety. RESULTS We identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715,705). An additional 5 studies investigating screening for those with distress (n = 21,491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone. CONCLUSIONS Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.
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Affiliation(s)
- Alex J Mitchell
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
| | - Isabel Espirito Santo Pereira
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
| | - Motahare Yadegarfar
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
| | - Shingai Pepereke
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
| | - Vongai Mugadza
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
| | - Brendon Stubbs
- Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK
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Muirhead L. Cancer risk factors among adults with serious mental illness. Am J Prev Med 2014; 46:S98-103. [PMID: 24512937 DOI: 10.1016/j.amepre.2013.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
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