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Chen X, Wang S, Shen W. The causal relationship between severe mental illness and risk of lung carcinoma. Medicine (Baltimore) 2024; 103:e37355. [PMID: 38489734 PMCID: PMC10939700 DOI: 10.1097/md.0000000000037355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/17/2024] Open
Abstract
Observational studies have suggested a link between severe mental illness (SMI) and risk of lung carcinoma (LC); however, causality has not been established. In this study, we conducted a two-sample, two-step Mendelian randomization (MR) investigation to uncover the etiological influence of SMI on LC risk and quantify the mediating effects of known modifiable risk factors. We obtained summary-level datasets for schizophrenia, major depressive disorder (MDD), and bipolar disorder (BD) from the Psychiatric Genomics Consortium (PGC). Data on single nucleotide polymorphisms (SNPs) associated with lung carcinoma (LC) were sourced from a recent large meta-analysis by McKay et al. We employed two-sample MR and two-step MR utilizing the inverse variance weighted method for causal estimation. Sensitivity tests were conducted to validate causal relationships. In two-sample MR, we identified schizophrenia as a risk factor for LC (OR = 1.06, 95% CI 1.02-1.11, P = 3.48E-03), while MDD (OR = 1.18, 95% CI 0.98-1.42, P = .07) and BD (OR = 1.07, 95% CI 0.99-1.15, P = .09) showed no significant association with LC. In the two-step MR, smoking accounted for 24.66% of the schizophrenia-LC risk association, and alcohol consumption explained 7.59% of the effect. Schizophrenia is a risk factor for lung carcinoma, and smoking and alcohol consumption are the mediating factors in this causal relationship. LC screening should be emphasized in individuals with schizophrenia, particularly in those who smoke and consume alcohol regularly.
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Affiliation(s)
- Xiaohan Chen
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, China
| | - Shudan Wang
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, China
| | - Weiyu Shen
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, China
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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Lennox L, Lambe K, Hindocha CN, Coronini-Cronberg S. What health inequalities exist in access to, outcomes from and experience of treatment for lung cancer? A scoping review. BMJ Open 2023; 13:e077610. [PMID: 37918927 PMCID: PMC10626811 DOI: 10.1136/bmjopen-2023-077610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES Lung cancer (LC) continues to be the leading cause of cancer-related deaths and while there have been significant improvements in overall survival, this gain is not equally distributed. To address health inequalities (HIs), it is vital to identify whether and where they exist. This paper reviews existing literature on what HIs impact LC care and where these manifest on the care pathway. DESIGN A systematic scoping review based on Arksey and O'Malley's five-stage framework. DATA SOURCES Multiple databases (EMBASE, HMIC, Medline, PsycINFO, PubMed) were used to retrieve articles. ELIGIBILITY CRITERIA Search limits were set to retrieve articles published between January 2012 and April 2022. Papers examining LC along with domains of HI were included. Two authors screened papers and independently assessed full texts. DATA EXTRACTION AND SYNTHESIS HIs were categorised according to: (a) HI domains: Protected Characteristics (PC); Socioeconomic and Deprivation Factors (SDF); Geographical Region (GR); Vulnerable or Socially Excluded Groups (VSG); and (b) where on the LC pathway (access to, outcomes from, experience of care) inequalities manifest. Data were extracted by two authors and collated in a spreadsheet for structured analysis and interpretation. RESULTS 41 papers were included. The most studied domain was PC (32/41), followed by SDF (19/41), GR (18/41) and VSG (13/41). Most studies investigated differences in access (31/41) or outcomes (27/41), with few (4/41) exploring experience inequalities. Evidence showed race, rural residence and being part of a VSG impacted the access to LC diagnosis, treatment and supportive care. Additionally, rural residence, older age or male sex negatively impacted survival and mortality. The relationship between outcomes and other factors (eg, race, deprivation) showed mixed results. CONCLUSIONS Findings offer an opportunity to reflect on the understanding of HIs in LC care and provide a platform to consider targeted efforts to improve equity of access, outcomes and experience for patients.
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Affiliation(s)
- Laura Lennox
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Kate Lambe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chandni N Hindocha
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Sophie Coronini-Cronberg
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- West London NHS Trust, London, UK
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Langballe R, Jakobsen E, Iachina M, Karlsen RV, Ehlers JH, Svendsen MN, Bodtger U, Hilberg O, Dalton SO, Bidstrup PE. Who are the vulnerable lung cancer patients at risk for not receiving first-line curative or palliative treatment? Acta Oncol 2023; 62:1301-1308. [PMID: 37656828 DOI: 10.1080/0284186x.2023.2252581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND To identify non-small-cell lung cancer (NSCLC) patients in need of comprehensive support, we examined the association between patient and disease-related factors of vulnerability related to not receiving guideline-recommended treatment. MATERIAL AND METHODS We identified 14,597 non-small-cell lung cancer (NSCLC) patients with performance status <3 during 2013-2018 in the Danish Lung Cancer Registry. Multivariate logistic regression models were used to estimate Odds Ratios (ORs) and 95% confidence intervals (CIs) for receiving guideline-recommended treatment according to stage, comorbidities, age, performance status, long distance to hospital, cohabitation status, education and alcohol abuse. RESULTS 21% of stage I-IIIA NSCLC patients did not receive curative treatment while 10% with stage IIIB-IV did not receive any oncological therapy. Factors associated with reduced likelihood of receiving curative treatment included: advanced stage (OR = 0.45; 95% CI = 0.42-0.49), somatic comorbidity (OR = 0.72; 95% CI = 0.63-0.83), age ≥ 80 years (OR = 0.59; 95% CI = 0.55-0.64), performance status = 2 (OR = 0.33; 95% CI = 0.28-0.39) and living alone (OR = 0.79; 95% CI = 0.69-0.90). Results were similar for stage IIIB-IV NSCLC patients, although a statistically significant association was also seen for long distances to the hospital (OR = 0.71; 95% CI = 0.58-0.86). CONCLUSIONS Several factors are associated with not receiving guideline-recommended NSCLC treatment with age, performance status, comorbidity and stage being most predictive of no treatment receipt. Efforts should be made to develop support for vulnerable lung cancer patients to improve adherence to optimal first-line therapy.
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense C, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense C, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Haar Ehlers
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Mads Nordahl Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Roskilde/Næstved, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Ole Hilberg
- Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
- Department of Respiratory Disease, Vejle Hospital, Vejle, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
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Steiling K, Kathuria H, Echieh CP, Ost DE, Rivera MP, Begnaud A, Celedón JC, Charlot M, Dietrick F, Duma N, Fong KM, Ford JG, Gould MK, Holguin F, Pérez-Stable EJ, Tanner NT, Thomson CC, Wiener RS, Wisnivesky J. Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e31-e46. [PMID: 36920066 PMCID: PMC10037482 DOI: 10.1164/rccm.202212-2216st] [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] [Indexed: 03/16/2023] Open
Abstract
Background: Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1) research methodology, 2) patient-level interventions, 3) clinician-level interventions, and 4) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: 1) need for methodologic guidelines for conducting research related to disparities in nodule management, 2) evaluating how social determinants of health influence lung nodule evaluation, 3) studying approaches to improve patient-clinician communication, and 4) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.
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Kisely S, Alotiby MKN, Protani MM, Soole R, Arnautovska U, Siskind D. Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta-analysis. Psychooncology 2023; 32:651-662. [PMID: 36892099 DOI: 10.1002/pon.6120] [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: 11/01/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. METHODS We undertook a systematic review and meta-analysis on access to guideline-appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre-existing SMI. Study designs included population-based cohort or case-control studies. RESULTS There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta-analyses. People with SMI had a reduced likelihood of guideline-appropriate care (RR = 0.83, 95% CI = 0.77-0.90). Meta-analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait-times to receiving guideline-appropriate care. The results for specific outcomes such as surgery, hormone, radio- or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. CONCLUSIONS People with SMI receive less and/or delayed guideline-appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.
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Affiliation(s)
- Steve Kisely
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Melinda M Protani
- University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Rebecca Soole
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Urska Arnautovska
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Dan Siskind
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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Wang YH, Aggarwal A, Stewart R, Davies EA. Impact of pre-existing mental health disorders on the receipt of guideline recommended cancer treatments: A systematic review. Psychooncology 2023; 32:307-330. [PMID: 36588188 DOI: 10.1002/pon.6081] [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: 07/22/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Disparities in cancer outcomes for individuals with pre-existing mental health disorders have already been identified, particularly for cancer screening and mortality. We aimed to systematically review the influence on the time from cancer diagnosis to cancer treatment, treatment adherence, and differences in receipt of guideline recommended cancer treatment. METHODS We included international studies published in English from 1 January 1995 to 23 May 2022 by searching MEDLINE, Embase, and APA PsycInfo. RESULTS This review identified 29 studies with 27 being published in the past decade. Most studies focused on breast, non-small cell lung and colorectal cancer and were of high or medium quality as assessed by the Newcastle Ottawa Scale. All studies were from high-income countries, and mostly included patients enrolled in national health insurance systems. Five assessed the impact on treatment delay or adherence, and 25 focused on the receipt of guideline recommended treatment. 20/25 studies demonstrated evidence that patients with pre-existing mental health disorders were less likely to receive guideline recommended therapies such as surgery or radiotherapy. In addition, there was a greater likelihood of receiving less intensive or modified treatment including systemic therapy. CONCLUSIONS Across different cancer types and treatment modalities there is evidence of a clear disparity in the receipt of guideline recommended cancer treatment for patients with pre-existing mental health disorders. The effect of pre-existing mental health disorders on treatment delay or adherence is under-researched. Future research needs to include low- and middle-income countries as well as qualitative investigations to understand the reasons for disparities in cancer treatment.
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Affiliation(s)
- Yueh-Hsin Wang
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer Society & Public Health, Comprehensive Cancer Centre, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elizabeth A Davies
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer Society & Public Health, Comprehensive Cancer Centre, Faculty of Life Sciences & Medicine, King's College London, London, UK
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How does severe mental illness impact on cancer outcomes in individuals with severe mental illness and cancer? A scoping review of the literature. J Med Imaging Radiat Sci 2023; 54:S104-S114. [PMID: 36804013 DOI: 10.1016/j.jmir.2023.01.007] [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: 09/11/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Individuals living with severe mental illness (SMI) have a reduced life expectancy of approximately 15-20 years compared to the general population1,2. Individuals with SMI and comorbid cancer have increased cancer related mortality rates compared to the non SMI population. This scoping review examines the current evidence in relation to the impact on cancer outcomes where individuals have a pre-existing SMI. METHODS Scopus, PsychINFO, PubMed, PsycArticles and the Cochrane Library were searched for peer reviewed research articles, published in English language between 2001 and 2021. Initial title and abstract screening, followed by full text screening sourced articles reporting on the impact of SMI and cancer on: stage at diagnosis, survival, treatment access or quality of life. Articles were quality appraised, and data were extracted and summarised. RESULTS The search yielded 1226 articles, 27 met the inclusion criteria. The search yielded no articles that met the inclusion criteria that were from the perspective of the service user or that were focused on the impact of SMI and cancer quality of life. Three themes were developed following analysis: Cancer related mortality, stage at diagnosis, and access to stage appropriate treatment. DISCUSSION The collective study of populations with comorbid SMI and cancer is complex and challenging without a large-scale cohort study. The studies yielded through this scoping review were heterogenous and often study multiple diagnoses of SMI and cancer. Collectively these indicate that cancer related mortality is increased in the population of individuals with pre-existing SMI and the SMI population are more likely to have an increased likelihood of metastatic disease at diagnosis and less likely to receive stage appropriate treatment. CONCLUSIONS Individuals with pre-existing SMI and cancer have increased cancer specific mortality. Comorbid SMI and cancer is complex, and individuals with SMI and cancer are less likely to receive optimal treatments, experience increased interruptions and delays to treatment.
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Irwin KE, Callaway CA, Corveleyn AE, Pappano CR, Barry MJ, Tiersma KM, Nelson ZE, Fields LE, Pirl WF, Greer JA, Temel JS, Ryan DP, Nierenberg AA, Park ER. Study protocol for a randomized trial of bridge: Person-centered collaborative care for serious mental illness and cancer. Contemp Clin Trials 2022; 123:106975. [PMID: 36307008 PMCID: PMC11033617 DOI: 10.1016/j.cct.2022.106975] [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: 07/08/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) experience inequities in cancer care that contribute to increased cancer mortality. Involving mental health at the time of cancer diagnosis may improve cancer care delivery for patients with SMI yet access to care remains challenging. Collaborative care is a promising approach to integrate mental health and cancer care that has not yet been studied in this marginalized population. METHODS/DESIGN We describe a 24-week, two-arm, single-site randomized trial of person-centered collaborative care (Bridge) for patients with SMI (schizophrenia, bipolar disorder, or major depression with psychiatric hospitalization) and their caregivers. 120 patients are randomized 1:1 to Bridge or Enhanced Usual Care (EUC) along with their caregivers. Researchers proactively identify individuals with SMI and a new breast, lung, gastrointestinal, or head and neck cancer that can be treated with curative intent. EUC includes informing oncologists about the patient's psychiatric diagnosis, notifying patients about available psychosocial services, and tracking patient and caregiver outcomes. Bridge includes a proactive assessment by psychiatry and social work, a person-centered, team approach including collaboration between mental health and oncology, and increased access to evidence-based psycho-oncology care. The primary outcome is cancer care disruptions evaluated by a blinded panel of oncologists. Secondary outcomes include patient and caregiver-reported outcomes and healthcare utilization. Barriers to Bridge implementation and dissemination are assessed using mixed methods. DISCUSSION This trial will inform efforts to systematically identify individuals with SMI and cancer and generate the first experimental evidence for the impact of person-centered collaborative care on cancer care for this underserved population.
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Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Catherine A Callaway
- Department of Psychology, University of California Berkeley, Berkeley, CA, United States of America
| | - Amy E Corveleyn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Catherine R Pappano
- Department of Psychology, University of Colorado Denver, Denver, CO, United States of America
| | - Maura J Barry
- University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America
| | - Keenae M Tiersma
- University of Washington Medical School, Seattle, WA, United States of America
| | - Zoe E Nelson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Lauren E Fields
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - William F Pirl
- Harvard Medical School, Boston, MA, United States of America; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - David P Ryan
- Harvard Medical School, Boston, MA, United States of America; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
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Wootten JC, Wiener JC, Blanchette PS, Anderson KK. Cancer incidence and stage at diagnosis among people with psychotic disorders: Systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102233. [PMID: 35952461 DOI: 10.1016/j.canep.2022.102233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/16/2022]
Abstract
Research regarding the incidence of cancer among people with psychotic disorders relative to the general population is equivocal, although the evidence suggests that they have more advanced stage cancer at diagnosis. We conducted a systematic review and meta-analysis to examine the incidence and stage at diagnosis of cancer among people with, relative to those without, psychotic disorders. We searched the MEDLINE, EMBASE, PsycINFO, and CINAHL databases. Articles were included if they reported the incidence and/or stage at diagnosis of cancer in people with psychotic disorders. Random effects meta-analyses were used to determine risk of cancer and odds of advanced stage cancer at diagnosis in people with psychosis, relative to those without psychotic disorders. A total of 40 articles were included in the review, of which, 31 were included in the meta-analyses. The pooled age-adjusted risk ratio for all cancers in people with psychotic disorders was 1.08 (95% CI: 1.01-1.15), relative to those without psychotic disorders, with significant heterogeneity by cancer site. People with psychotic disorders had a higher incidence of breast, oesophageal, colorectal, testicular, uterine, and cervical cancer, and a lower incidence of skin, prostate, and thyroid cancer. People with psychotic disorders also had 22% higher (95% CI: 2-46%) odds of metastases at diagnosis, compared to those without psychotic disorders. Our systematic review found a significant difference in overall cancer incidence among people diagnosed with psychotic disorders and people with psychotic disorders were more likely to present with advanced stage cancer at diagnosis. This finding may reflect a need for improved access to and uptake of cancer screening for patients diagnosed with psychotic disorders.
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Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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DeBenedectis CM, Spalluto LB, Americo L, Bishop C, Mian A, Sarkany D, Kagetsu NJ, Slanetz PJ. Health Care Disparities in Radiology-A Review of the Current Literature. J Am Coll Radiol 2022; 19:101-111. [PMID: 35033297 DOI: 10.1016/j.jacr.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
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Affiliation(s)
- Carolynn M DeBenedectis
- Vice-Chair, Education; Director, Radiology Residency Program; Department of Radiology, President-elect, New England Roentgen Ray Society; and Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Lucy B Spalluto
- Vice-Chair, Health Equity; Director, Women in Radiology; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research; and Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Lisa Americo
- Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Casey Bishop
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Asim Mian
- Director, Radiology Residency Program; Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - David Sarkany
- Director, Radiology Residency Program; Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Nolan J Kagetsu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priscilla J Slanetz
- Vice-Chair, Academic Affairs; Associate Program Director, Radiology Residency Program, Boston Medical Center; President-elect Massachusetts Radiologic Society; Secretary, Association of University Radiologists; Chair, Breast Imaging Panel 2, ACR Appropriateness Guidelines Committee; and Department of Radiology, Boston Medical Center, Boston, Massachusetts
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13
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Irwin KE, Ko N, Walsh EP, Decker V, Arrillaga-Romany I, Plotkin SR, Franas J, Gorton E, Moy B. OUP accepted manuscript. Oncologist 2022; 27:518-524. [PMID: 35443045 PMCID: PMC9256021 DOI: 10.1093/oncolo/oyac069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
We define cancer equity as all people having as the same opportunity for cancer prevention, treatment, and survivorship care. However, marginalized populations continue to experience avoidable and unjust disparities in cancer care, access to clinical trials, and cancer survival. Racial and ethnic minorities, and individuals with low socioeconomic status, Medicaid insurance, limited health literacy, disabilities, and mental health disorders are more likely to experience delays to cancer diagnosis and less likely to receive guideline-concordant cancer care. These disparities are impacted by the social determinants of health including structural discrimination, racism, poverty, and inequities in access to healthcare and clinical trials. There is an urgent need to develop and adapt evidence-based interventions in collaboration with community partners that have potential to address the social determinants of health and build capacity for cancer care for underserved populations. We established the Virtual Equity Hub by developing a collaborative network connecting a comprehensive cancer center, academic safety net hospital, and community health centers and affiliates. The Virtual Equity Hub utilizes a virtual tumor board, an evidence-based approach that increases access to multi-specialty cancer care and oncology subspecialty expertise. We adapted the tumor board model by engaging person-centered teams of multi-disciplinary specialists across health systems, addressing the social determinants of health, and applying community-based research principles with a focus on populations with poor cancer survival. The virtual tumor board included monthly videoconferences, case discussion, sharing of expertise, and a focus on addressing barriers to care and trial participation. Specifically, we piloted virtual tumor boards for breast oncology, neuro-oncology, and individuals with cancer and serious mental illness. The Virtual Equity Hub demonstrated promise at building capacity for clinicians to care for patients with complex needs and addressing barriers to care. Research is needed to measure the impact, reach, and sustainability of virtual equity models for patients with cancer.
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Affiliation(s)
- Kelly E Irwin
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naomi Ko
- Department of Medical Oncology, Boston Medical Center, Boston, MA, USA
| | | | - Veronica Decker
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Isabel Arrillaga-Romany
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Scott R Plotkin
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emily Gorton
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Beverly Moy
- Corresponding author: Beverly Moy, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9A, Boston, MA 02114, USA.
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14
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Viprey M, Pauly V, Salas S, Baumstarck K, Orleans V, Llorca PM, Lancon C, Auquier P, Boyer L, Fond G. Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1571-1578. [PMID: 32876751 DOI: 10.1007/s00406-020-01186-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014-2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p < 0.0001; surgery 0.73 [0.59;0.90]; p < 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.
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Affiliation(s)
- Marie Viprey
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Medical Information, APHM, Marseille, France
| | | | - Karine Baumstarck
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | | | | | - Christophe Lancon
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Psychiatry, APHM, Marseille, France
| | - Pascal Auquier
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France.,Department of Medical Information, APHM, Marseille, France
| | - Guillaume Fond
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France. .,Department of Epidemiology and Health Economics, APHM, Marseille, France. .,Department of Medical Information, APHM, Marseille, France.
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15
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Boakye D, Günther K, Niedermaier T, Haug U, Ahrens W, Nagrani R. Associations between comorbidities and advanced stage diagnosis of lung, breast, colorectal, and prostate cancer: A systematic review and meta-analysis. Cancer Epidemiol 2021; 75:102054. [PMID: 34773768 DOI: 10.1016/j.canep.2021.102054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/20/2022]
Abstract
Comorbidities and advanced stage diagnosis (ASD) are both associated with poorer cancer outcomes, but the association between comorbidities and ASD is poorly understood. We summarized epidemiological evidence on the association between comorbidities and ASD of selected cancers in a systematic review and meta-analysis. We searched PubMed and Web of Science databases up to June 3rd, 2021 for studies assessing the association between comorbidities and ASD of lung, breast, colorectal, or prostate cancer. Summary odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random-effects models. Also, potential variations in the associations between comorbidities and ASD by cancer type were investigated using random-effects meta-regression. Thirty-seven studies were included in this review, including 8,069,397 lung, breast, colorectal, and prostate cancer patients overall. The Charlson comorbidity index score was positively associated with ASD (stages III-IV) of breast cancer but was inversely associated with ASD of lung cancer (pinteraction = 0.004). Regarding specific comorbidities, diabetes was positively associated with ASD (OR = 1.17, 95%CI = 1.09-1.26), whereas myocardial infarction was inversely associated with ASD (OR = 0.84, 95%CI = 0.75-0.95). The association between renal disease and ASD differed by cancer type (pinteraction < 0.001). A positive association was found with prostate cancer (OR = 2.02, 95%CI = 1.58-2.59) and an inverse association with colorectal cancer (OR = 0.84, 95%CI = 0.70-1.00). In summary, certain comorbidities (e.g., diabetes) may be positively associated with ASD of several cancer types. It needs to be clarified whether closer monitoring for early cancer signs or screening in these patients is reasonable, considering the problem of over-diagnosis particularly relevant in patients with short remaining life expectancy such as those with comorbidities. Also, evaluation of the cost-benefit relationship of cancer screening according to the type and severity of comorbidity (rather than summary scores) may be beneficial for personalized cancer screening in populations with chronic diseases.
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Affiliation(s)
- Daniel Boakye
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Kathrin Günther
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Rajini Nagrani
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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16
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Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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17
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Flores EJ, Neil JM, Tiersma KM, Pappano CR, Mulligan C, Van Alphen MU, Park ER, Irwin KE. Feasibility and Acceptability of a Collaborative Lung Cancer Screening Educational Intervention Tailored for Individuals With Serious Mental Illness. J Am Coll Radiol 2021; 18:1624-1634. [PMID: 34375628 DOI: 10.1016/j.jacr.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and changes in attitudes toward LCS (phase 2). METHODS Phase 1: We conducted three focus groups with mental health, primary care, and radiology clinicians and utilized rapid qualitative analysis to adapt the LCS intervention (LCS walk-through video and smoking cessation handouts) tailored for individuals with SMI. Phase 2: We enrolled LCS-eligible patients with SMI (n = 15) and assessed the feasibility (>50% enrollment; >75% completion) and acceptability (>75% overall satisfaction) of an LCS educational intervention delivered by a radiologist and a mental health clinician at a community mental health clinic. We explored changes in participant attitudes about lung cancer, LCS, and smoking before and after the intervention. RESULTS Phase 1: Focus groups with primary care (n = 5), radiologists (n = 9), and mental health clinicians (n = 6) recommended person-centered language and adapting a video demonstrating the process of LCS to address concerns specific to SMI, including paranoia and concrete thinking. Phase 2: Fifty percent (15 of 30) of eligible patients enrolled in the LCS intervention, 100% (15 of 15) completed the intervention, and 93% (14 of 15) were satisfied with the intervention. Participants reported a significantly greater worry about developing lung cancer postintervention, but there were no other significant differences. CONCLUSIONS Radiologists can partner with primary care and community mental health clinics to lead LCS equity among individuals with SMI.
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Affiliation(s)
- Efrén J Flores
- Officer of Radiology, Community, and Health Equity, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jordan M Neil
- Assistant Professor, Department of Family and Preventive Medicine, TSET Health Promotion Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Keenae M Tiersma
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; North Suffolk Mental Health Association, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Catherine R Pappano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Caitlin Mulligan
- North Suffolk Mental Health Association, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Manjola U Van Alphen
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Chief Medical Officer, Medical Director, Division of Ambulatory Services, North Suffolk Mental Health Association, Boston, Massachusetts
| | - Elyse R Park
- Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts; Associate Director, Survivorship Research and Psychosocial Services for the MGH Cancer Center, Director of Behavioral Sciences, MGH Tobacco Treatment & Research Center, the Mongan Institute, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Director of Behavioral Research, MGH Benson-Henry Institute for Mind Body Medicine, Boston, Massachusetts
| | - Kelly E Irwin
- The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor of Psychiatry, Harvard Medical School, Harvard Medical School, Boston, Massachusetts; Director, Collaborative Care and Community Engagement Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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18
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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: 26] [Impact Index Per Article: 8.7] [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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19
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Kohn L, Christiaens W, Detraux J, De Lepeleire J, De Hert M, Gillain B, Delaunoit B, Savoye I, Mistiaen P, Jespers V. Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives. Front Psychiatry 2021; 12:798530. [PMID: 35153863 PMCID: PMC8825501 DOI: 10.3389/fpsyt.2021.798530] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists. Physical illnesses, mainly cardiovascular diseases, substantially contribute to the high mortality rates in patients with SMI. Disparities in somatic health care access, utilisation, and provision contribute to these poor physical health outcomes. METHODS A qualitative study, using semi-structured interviews, was set up to explore SMI patients' and healthcare professionals' perspectives on somatic health care in different psychiatric settings of the three Belgian regions (Flanders, Brussels, Wallonia). Interviews were digitally recorded and transcribed prior to qualitative inductive thematic analysis, using Nvivo software. The COnsolidated criteria for REporting Qualitative research (COREQ) were used for reporting methods and findings. RESULTS Collaboration and information flows between psychiatric healthcare professionals, non-psychiatric healthcare professionals, and persons with SMI were troublesome. This seemed to be mainly due to stigma and prejudice and challenging communication and data transfer. Lack of sufficient training and experience to identify and treat somatic health problems in people with SMI (for psychiatrists and psychiatric nurses) and lack of psychiatric knowledge and feeling or sensitivity for psychiatric patients (for non-psychiatric healthcare professionals) further complicated adequate somatic health care. Finally, optimal somatic follow-up of patients with SMI was hampered by organisational problems (unavailability of equipment, unadapted infrastructure, understaffing, hospital pharmacy issues, and insufficient health promotion/lifestyle interventions), patient-related issues (unawareness of physical problems, non-adherence, need for accompaniment) and financial barriers. CONCLUSION There is an urgent need for integrated somatic and mental healthcare systems and a cultural change. Psychiatrists and primary care providers continue to consider the mental and physical health of their patients as mutually exclusive responsibilities due to a lack of sufficient training and experience, poor or absent liaison links, time constraints and organisational and financial barriers. Modifying these aspects will improve the quality of somatic health care for these vulnerable patients.
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Affiliation(s)
- Laurence Kohn
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Johan Detraux
- Department of Neurosciences, Public Health Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, Catholic University of Leuven, Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Center for Clinical Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Benoit Gillain
- Société Royale de Santé Mentale de Belgique, Ottignies, Belgium
| | | | | | | | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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21
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Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:493-497. [PMID: 33343262 DOI: 10.1176/appi.focus.18402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).
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Affiliation(s)
- George A Keepers
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Laura J Fochtmann
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Joan M Anzia
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Sheldon Benjamin
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Jeffrey M Lyness
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Ramin Mojtabai
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Mark Servis
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Art Walaszek
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Peter Buckley
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | | | - Alexander S Young
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Amanda Degenhardt
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Seung-Hee Hong
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
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22
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Grassi L, Riba M. Cancer and severe mental illness:
Bi‐directional
problems and potential solutions. Psychooncology 2020; 29:1445-1451. [DOI: 10.1002/pon.5534] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences University of Ferrara Ferrara Italy
| | - Michelle Riba
- Department of Psychiatry University of Michigan Ann Arbor Michigan USA
- University of Michigan Depression Center Ann Arbor Michigan USA
- Psycho‐oncology Program University of Michigan Rogel Cancer Center Ann Arbor Michigan USA
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23
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Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. Am J Psychiatry 2020; 177:868-872. [PMID: 32867516 DOI: 10.1176/appi.ajp.2020.177901] [Citation(s) in RCA: 308] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- George A Keepers
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Laura J Fochtmann
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Joan M Anzia
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Sheldon Benjamin
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Jeffrey M Lyness
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Ramin Mojtabai
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Mark Servis
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Art Walaszek
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Peter Buckley
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | | | - Alexander S Young
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Amanda Degenhardt
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Seung-Hee Hong
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
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- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
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24
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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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Flores EJ, Park ER, Irwin KE. Improving Lung Cancer Screening Access for Individuals With Serious Mental Illness. J Am Coll Radiol 2019; 16:596-600. [PMID: 30947893 DOI: 10.1016/j.jacr.2018.12.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022]
Abstract
Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system-level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness.
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Affiliation(s)
- Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard. Medical School, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Harvard. Medical School, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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26
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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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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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Irwin KE, Steffens EB, Yoon Y, Flores EJ, Knight HP, Pirl WF, Freudenreich O, Henderson DC, Park ER. Lung Cancer Screening Eligibility, Risk Perceptions, and Clinician Delivery of Tobacco Cessation Among Patients With Schizophrenia. Psychiatr Serv 2019; 70:927-934. [PMID: 31357921 PMCID: PMC8386131 DOI: 10.1176/appi.ps.201900044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, and receipt of tobacco cessation interventions from psychiatry and primary care. METHODS The authors performed a cross-sectional survey and medical record review with 112 adults with schizophrenia treated with clozapine in a community mental health clinic (CMHC). RESULTS Among older participants (ages 55-77 years) with schizophrenia, 34% met the criteria for lung screening on the basis of smoking history (heavy current or former smokers), and more than half believed they had a low risk of developing lung cancer. Of all participants, 88% had visited their primary care provider (PCP) in the past year; PCPs represented 35 different practices. Only one in three current smokers reported that their PCP or psychiatrist assisted them in obtaining medications for tobacco cessation. CONCLUSIONS Given smoking history, many older adults with schizophrenia have potential to benefit from lung screening, yet most older participants underestimated their lung cancer risk. Although participants regularly accessed care, PCP and psychiatric visits may be missed opportunities to engage patients with schizophrenia in tobacco cessation and decrease preventable premature mortality. Embedding interventions in a CMHC, a centralized access point of care delivery for patients with schizophrenia, may have unique potential to increase uptake of cancer screening and tobacco cessation interventions.
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Affiliation(s)
- Kelly E Irwin
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Eleanor B Steffens
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - YooJin Yoon
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Efren J Flores
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Helen P Knight
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Oliver Freudenreich
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - David C Henderson
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Elyse R Park
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
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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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Irwin KE, Park ER, Fields LE, Corveleyn AE, Greer JA, Perez GK, Callaway CA, Jacobs JM, Nierenberg AA, Temel JS, Ryan DP, Pirl WF. Bridge: Person-Centered Collaborative Care for Patients with Serious Mental Illness and Cancer. Oncologist 2019; 24:901-910. [PMID: 30696722 PMCID: PMC6656464 DOI: 10.1634/theoncologist.2018-0488] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative care trial for SMI and cancer. SUBJECTS, MATERIALS, AND METHODS We developed the Bridge intervention for patients with SMI (schizophrenia, bipolar disorder, and severe major depression) and cancer. Bridge includes proactive identification of SMI, person-centered care from a psychiatrist and case manager, and collaboration with oncology. We conducted a 12-week, single-group trial in patients with SMI and a new breast, gastrointestinal, lung, or head/neck cancer. We assessed the feasibility of patient identification, enrollment and study completion; evaluated acceptability and perceived benefit with exit interviews with patients, caregivers, and oncology clinicians; and examined change in psychiatric symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS From November 2015 to April 2016, 30/33 eligible patients (90.9%) enrolled, and 25/29 (86.2%) completed assessments at all timepoints, meeting feasibility criteria. Of 24 patients, 23 (95.8%) found meeting with the psychiatrist helpful; 16/19 caregivers (84.2%) shared that Bridge addressed key caregiving challenges. Oncology clinicians evaluated Bridge as "very" or "most" useful for 94.3% of patients. Exit interviews with all participant groups suggested that Bridge fostered patient-clinician trust, increased access to psychiatric treatment, and enabled patients to initiate and complete cancer treatment. Psychiatric symptoms on the BPRS improved from baseline to 12 weeks. CONCLUSION Bridge is a feasible and acceptable care delivery model for patients with SMI, their caregivers, and oncology clinicians. Randomized trials are warranted to assess the efficacy of improving cancer outcomes in this underserved population. IMPLICATIONS FOR PRACTICE Serious mental illness affects 13 million U.S. adults who experience increased cancer mortality. To improve outcomes, new models of integrated oncology and mental health care are urgently needed. This study found that it was feasible to identify, enroll, and retain patients with serious mental illness and a new cancer in a trial of integrated mental health and cancer care (Bridge). Patients, caregivers, and oncologists reported that Bridge facilitated the initiation and completion of cancer care. Randomized trials are warranted to investigate the impact on cancer outcomes. Trial procedures may inform consent, engagement, and trial retention for patients with mental illness.
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Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren E Fields
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy E Corveleyn
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jamie M Jacobs
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David P Ryan
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Irwin KE, Moy B, Fields LE, Callaway CA, Park ER, Wirth L. Expanding Access to Cancer Clinical Trials for Patients With Mental Illness. J Clin Oncol 2019; 37:1524-1528. [PMID: 30986118 DOI: 10.1200/jco.18.01881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kelly E Irwin
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Beverly Moy
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Lauren E Fields
- 1 Massachusetts General Hospital, Boston, MA.,3 Columbia University, New York, NY
| | | | - Elyse R Park
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Lori Wirth
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
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Impact of severe mental illness on cancer stage at diagnosis and subsequent mortality: A population-based register study. Schizophr Res 2018; 201:62-69. [PMID: 29891274 DOI: 10.1016/j.schres.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Excess mortality in individuals with severe mental illness (SMI) is often explained by physical comorbidity and suboptimal healthcare. Cancer is a prevalent cause of death, and tumour stage at diagnosis is a strong predictor of mortality. We aimed to study cancer incidence, disease stage at diagnosis and subsequent mortality in individuals with SMI compared to individuals without SMI. METHODS The entire Danish population was followed in 1978-2013 using nationwide registries. Cancer incidence and subsequent mortality stratified by disease stage were compared in individuals with and without SMI. Cox regression was used to estimate incidence rate ratios (IRR) and mortality rate ratios (MRR). Cancer was examined overall and grouped by major aetiological factors. RESULTS The overall cancer incidence rate was lower in males with SMI than in males without SMI; IRR = 0.89 (95% CI: 0.85-0.94), but rates were similar in females with SMI and without SMI; IRR = 1.03 (95% CI: 0.99-1.07). The overall mortality rate was higher in individuals with SMI than those without; MRR = 1.56 (95% CI: 1.48-1.64) for males and MRR = 1.49 (95% CI: 1.43-1.56) for females. Incidence rates and mortality rates showed similar estimates when stratified by tumour stage and aetiology. CONCLUSIONS We found lower cancer incidence in males with SMI compared to males without SMI and similar incidence in the two groups of women. Higher subsequent mortality was found in both sexes with SMI. The excess mortality was not explained by more advanced stages of cancer; future studies should evaluate the effect of cancer treatment and rehabilitation.
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Keinänen J, Mantere O, Markkula N, Partti K, Perälä J, Saarni SI, Härkänen T, Suvisaari J. Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study. Schizophr Res 2018; 192:113-118. [PMID: 28499768 DOI: 10.1016/j.schres.2017.04.048] [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: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
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Affiliation(s)
- Jaakko Keinänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Outi Mantere
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC H4H 1R3, Canada.
| | - Niina Markkula
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile.
| | - Krista Partti
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; University of Helsinki, Doctoral Program in Clinical Research, P.O. Box 700, FIN-00029 HUS, Finland.
| | - Jonna Perälä
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Samuli I Saarni
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Turku University Hospital and the University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Health Monitoring Unit, P.O. Box 30, FIN-00271, Helsinki, Finland.
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland.
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Irwin KE, Park ER, Shin JA, Fields LE, Jacobs JM, Greer JA, Taylor JB, Taghian AG, Freudenreich O, Ryan DP, Pirl WF. Predictors of Disruptions in Breast Cancer Care for Individuals with Schizophrenia. Oncologist 2017; 22:1374-1382. [PMID: 28559411 PMCID: PMC5679818 DOI: 10.1634/theoncologist.2016-0489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/12/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with schizophrenia experience markedly increased breast cancer mortality, yet reasons for this disparity are poorly understood. We sought to characterize disruptions in breast cancer care for patients with schizophrenia and identify modifiable predictors of those disruptions. MATERIALS AND METHODS We performed a medical record review of 95 patients with schizophrenia and breast cancer treated at an academic cancer center between 1993 and 2015. We defined cancer care disruptions as processes that interfere with guideline-concordant cancer care, including delays to diagnosis or treatment, deviations from stage-appropriate treatment, and interruptions in treatment. We hypothesized that lack of psychiatric treatment at cancer diagnosis would be associated with care disruptions. RESULTS Half of patients with schizophrenia experienced at least one breast cancer care disruption. Deviations in stage-appropriate treatment were associated with breast cancer recurrence at 5 years (p = .045). Patients without a documented psychiatrist experienced more delays (p = .016), without documented antipsychotic medication experienced more deviations (p = .007), and with psychiatric hospitalizations after cancer diagnosis experienced more interruptions (p < .0001). Independent of stage, age, and documented primary care physician, lack of documented antipsychotic medication (odds ratio [OR] = 4.97, 95% confidence interval [CI] = 1.90, 12.98) and psychiatric care (OR = 4.56, 95% CI = 1.37, 15.15) predicted cancer care disruptions. CONCLUSION Disruptions in breast cancer care are common for patients with schizophrenia and are associated with adverse outcomes, including cancer recurrence. Access to psychiatric treatment at cancer diagnosis may protect against critical disruptions in cancer care for this underserved population. IMPLICATIONS FOR PRACTICE Disruptions in breast cancer care are common for patients with schizophrenia, yet access to mental health treatment is rarely integrated into cancer care. When oncologists documented a treating psychiatrist and antipsychotic medication, patients had fewer disruptions in breast cancer care after adjusting for age, cancer stage, and access to primary care. Addressing psychiatric comorbidity at breast cancer diagnosis may increase the likelihood that patients with schizophrenia receive timely, stage-appropriate cancer treatment. Comanagement of schizophrenia and breast cancer at cancer diagnosis may be one key strategy to decrease inequities in cancer treatment and improve cancer survival in this underserved population.
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Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer A Shin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren E Fields
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jamie M Jacobs
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John B Taylor
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David P Ryan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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van Laarhoven HWM, Pijnenburg LJ, Hulshof MCCM. On the Receiving End of Autonomy and Law. Oncologist 2017; 22:1143-1145. [PMID: 28606973 PMCID: PMC5599188 DOI: 10.1634/theoncologist.2016-0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/13/2017] [Indexed: 11/17/2022] Open
Abstract
It is well-recognized that mental illness is associated with a higher case fatality rate from cancer, although the incidence of cancer is no greater than in the general population. This narrative focuses on the efforts of a multidisciplinary team to guide a patient, who was experiencing psychotic episodes, through chemotherapy while staying within the limits of the law.
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Affiliation(s)
| | - Lisa J Pijnenburg
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
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Lasebikan VO, Azegbeobor J. Medical Co-morbidities Among Patients with Severe Mental Illnesses in a Community Health Facility in Nigeria. Community Ment Health J 2017; 53:736-746. [PMID: 27888379 DOI: 10.1007/s10597-016-0063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/22/2016] [Indexed: 01/05/2023]
Abstract
To examine prevalence of medical comorbidity (MCM) in schizophrenia (n = 1310) and in bipolar disorder (n = 1307) and the association of high burden of MCM (≥3 MCM) with duration of untreated illness, number of episodes, functioning, poly-medication and lifetime hospitalization for the mental disorder. Participants were recruited from a private psychiatric facility in Ibadan, Nigeria between 2004 and 2013 and enquiry made about the lifetime occurrence of 20 common chronic diseases including common tropical diseases. Psychiatric diagnosis was made using the Structured Clinical Interview for DSM IV Axis I disorder (SCID). Except for nutritional anemia, dermatitis and intestinal Helminthiasis, patients with schizophrenia were not at higher odds of reporting MCM than those with bipolar disorder. DUI ≥2 years, episodes of illness ≥3, being on multiple neuroleptics and history of previous hospitalization were significantly associated with high burden of MCM in schizophrenia and episodes of illness ≥3, reduced functioning and history of previous hospitalization with bipolar disorder. Schizophrenia and bipolar disorder are associated with high rates of medical comorbidity. Treatment of this medical comorbidity is essential in order to improve the outcomes for patients with bipolar disorder and schizophrenia.
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Affiliation(s)
- Victor Olufolahan Lasebikan
- Consultation Liaison Unit, Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria.
| | - Joachim Azegbeobor
- Department of Psychiatry, University College Hospital, Ibadan, PMB 5116, Ibadan, Nigeria
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Zhuo C, Tao R, Jiang R, Lin X, Shao M. Cancer mortality in patients with schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2017; 211:7-13. [PMID: 28596246 DOI: 10.1192/bjp.bp.116.195776] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/22/2017] [Accepted: 02/14/2017] [Indexed: 01/12/2023]
Abstract
BackgroundPrevious studies have reported conflicting results on the association between schizophrenia and cancer mortality.AimsTo summarise available evidence and quantify the association between schizophrenia and cancer mortality using meta-analysis.MethodWe systematically searched literature in the PubMed and Embase databases. Risk estimates and 95% confidence intervals reported in individual studies were pooled using the DerSimonian-Laird random-effects model.ResultsWe included 19 studies in the meta-analysis. Among them, 15 studies reported standardised mortality ratios (SMRs) comparing patients with schizophrenia with the general population, and the pooled SMR was 1.40 (95% CI 1.29-1.52, P < 0.001). The other four studies reported hazard ratios (HRs) comparing individuals with schizophrenia with those without schizophrenia; the pooled HR was 1.51 (95% CI 1.13-2.03, P = 0.006).ConclusionsPatients with schizophrenia are at a significantly increased risk of cancer mortality compared with the general population or individuals without schizophrenia.
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Affiliation(s)
- Chuanjun Zhuo
- Chuanjun Zhuo, MD, PhD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang and Department of Psychiatry, Tianjin Anding Hospital, Hexi District and Dongli District, Tianjin, China; Ran Tao, MD, Department of Psychiatry, Chinese PLA (people's Liberation Army) Hospital, Dongzhimen, Dongcheng District, Beijing; Ronghuan Jiang, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing; Xiaodong Lin, MD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang, China; Mingjing Shao, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing, China
| | - Ran Tao
- Chuanjun Zhuo, MD, PhD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang and Department of Psychiatry, Tianjin Anding Hospital, Hexi District and Dongli District, Tianjin, China; Ran Tao, MD, Department of Psychiatry, Chinese PLA (people's Liberation Army) Hospital, Dongzhimen, Dongcheng District, Beijing; Ronghuan Jiang, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing; Xiaodong Lin, MD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang, China; Mingjing Shao, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing, China
| | - Ronghuan Jiang
- Chuanjun Zhuo, MD, PhD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang and Department of Psychiatry, Tianjin Anding Hospital, Hexi District and Dongli District, Tianjin, China; Ran Tao, MD, Department of Psychiatry, Chinese PLA (people's Liberation Army) Hospital, Dongzhimen, Dongcheng District, Beijing; Ronghuan Jiang, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing; Xiaodong Lin, MD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang, China; Mingjing Shao, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing, China
| | - Xiaodong Lin
- Chuanjun Zhuo, MD, PhD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang and Department of Psychiatry, Tianjin Anding Hospital, Hexi District and Dongli District, Tianjin, China; Ran Tao, MD, Department of Psychiatry, Chinese PLA (people's Liberation Army) Hospital, Dongzhimen, Dongcheng District, Beijing; Ronghuan Jiang, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing; Xiaodong Lin, MD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang, China; Mingjing Shao, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing, China
| | - Mingjing Shao
- Chuanjun Zhuo, MD, PhD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang and Department of Psychiatry, Tianjin Anding Hospital, Hexi District and Dongli District, Tianjin, China; Ran Tao, MD, Department of Psychiatry, Chinese PLA (people's Liberation Army) Hospital, Dongzhimen, Dongcheng District, Beijing; Ronghuan Jiang, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing; Xiaodong Lin, MD, Department of Psychiatry, Wenzhou Seventh people's Hospital, Wenzhou, Zhejiang, China; Mingjing Shao, MD, Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Haidian District, Beijing, China
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Affiliation(s)
- Kelly E Irwin
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Chou FHC, Tsai KY, Wu HC, Shen SP. Cancer in patients with schizophrenia: What is the next step? Psychiatry Clin Neurosci 2016; 70:473-488. [PMID: 27392126 DOI: 10.1111/pcn.12420] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 12/15/2022]
Abstract
People with schizophrenia, who constitute approximately 0.3-1% of the general population, have a nearly 20% shorter life expectancy than the general population. The incidence of varied types of cancers in patients with schizophrenia is controversial. The majority of previous research has demonstrated that patients who have schizophrenia and cancer have early mortality compared to the general population with cancer. The causes of early mortality in patients with schizophrenia and cancer might be attributed to a lower cancer screening rate and lack of effective treatment, including: (i) patient factors, such as poor lifestyle, passive attitude toward treatment, or comorbidity; (ii) physician factors, such as physician bias, which may decrease the delivery of care for individuals with mental disorders; and (iii) hospital administration factors, such as stigma and discrimination. Additional studies on patients with schizophrenia and cancer are warranted and should include the following: a comprehensive review of previous studies; a focus on differentiating the specific types of cancer; and methods for improvement. To decrease the early mortality of patients with schizophrenia, the following measures are proposed: (i) enhance early detection and early treatment, such as increasing the cancer screening rate for patients with schizophrenia; (ii) provide effective, timely treatment and rehabilitation; (iii) improve patients' psychiatric symptoms and cognitive impairment; (iv) promote healthy behavior in the general population and emphasize healthy lifestyles in vulnerable populations; and (v) remove the stigma of schizophrenia. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this group of patients.
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Affiliation(s)
- Frank H-C Chou
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Graduate Institute of Health Care, Meiho University, Ping-Tong County, Taiwan
| | - Kuan-Yi Tsai
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Shih-Pei Shen
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
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Abstract
Psychiatric illnesses increase the morbidity and mortality of comorbid medical disease, and current research targets the identification of specific mechanisms that account for this association. Psychotic illness complicates the management of chronic diseases where self-care activities often play a major role, such as in the regulation of blood glucose levels in diabetes. In this issue, Wykes et al. describe an interactive relationship between cognitive functioning and negative symptoms, self-efficacy, and diabetic control in patients with psychotic illnesses and Type 1 diabetes. Although high self-efficacy was associated with better hemoglobin A1C levels in patients with mild negative symptoms and higher cognitive function, in patients with more severe negative symptoms and lower cognitive function, high-self-efficacy was linked to higher A1C levels. These findings point to the need for designing diabetes management plans based on careful assessments of specific psychiatric symptomatology in this population. Severe mental illness is also associated with poor general physical health and higher rates of somatic complaints. Madan and colleagues describe in this issue an integrated model of psychiatric and medical care that substantially reduced physical symptoms in patients with severe mental illness during an 8-week hospitalization, with striking improvements in those presenting with substance abuse and sleep disorders. If these findings are shown to persist after discharge, then accountable care organizations should be encouraged to incorporate this more aggressive approach to caring for this vulnerable population. Such targeted approaches are likely to result in decreased utilization of outpatient medical services and improved long-term outcomes.
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Weinstein LC, Stefancic A, Cunningham AT, Hurley KE, Cabassa LJ, Wender RC. Cancer screening, prevention, and treatment in people with mental illness. CA Cancer J Clin 2016; 66:134-51. [PMID: 26663383 PMCID: PMC4783271 DOI: 10.3322/caac.21334] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
People with mental illness die decades earlier in the United States compared with the general population. Most of this disparity is related to preventable and treatable chronic conditions, with many studies finding cancer as the second leading cause of death. Individual lifestyle factors, such as smoking or limited adherence to treatment, are often cited as highly significant issues in shaping risk among persons with mental illness. However, many contextual or systems-level factors exacerbate these individual factors and may fundamentally drive health disparities among people with mental illness. The authors conducted an integrative review to summarize the empirical literature on cancer prevention, screening, and treatment for people with mental illness. Although multiple interventions are being developed and tested to address tobacco dependence and obesity in these populations, the evidence for effectiveness is quite limited, and essentially all prevention interventions focus at the individual level. This review identified only one published article describing evidence-based interventions to promote cancer screening and improve cancer treatment in people with mental illness. On the basis of a literature review and the experience and expertise of the authors, each section in this article concludes with suggestions at the individual, interpersonal, organizational, community, and policy levels that may improve cancer prevention, screening, and treatment in people with mental illness.
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Affiliation(s)
- Lara C Weinstein
- Associate Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Ana Stefancic
- Staff Research Associate, Columbia University-School of Social Work, New York, NY
| | - Amy T Cunningham
- Clinical Research Coordinator III, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Katelyn E Hurley
- Clinical Research Specialist, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA and Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
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Cunningham R, Sarfati D, Stanley J, Peterson D, Collings S. Cancer survival in the context of mental illness: a national cohort study. Gen Hosp Psychiatry 2015; 37:501-6. [PMID: 26160056 DOI: 10.1016/j.genhosppsych.2015.06.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/29/2015] [Accepted: 06/04/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the reasons for worse cancer survival in people with experience of mental illness, including differences by cancer type and psychiatric diagnosis. METHOD New Zealand breast and colorectal cancer registrations (2006-2010) were linked to psychiatric hospitalization records for adults (18-64 years). Cancer-specific survival was compared for recent psychiatric service users and nonusers using Cox regression. The contributions of deprivation, comorbidity and stage at diagnosis were assessed for those with schizophrenia or bipolar affective disorder (Group A) and others using mental health services (Group B). RESULTS Of 8762 and 4022 people with breast and colorectal cancer respectively, 440 (breast) and 190 (colorectal) had recent contact with psychiatric services. After adjusting for confounding, risk of death from breast cancer was increased for Group A [Hazard Ratio (HR) 2.55 (95% confidence interval 1.49-4.35)] and B [HR 1.62 (1.09-2.39)] and from colorectal cancer for Group A [HR 2.92 (1.75-4.87)]. Later stage at diagnosis contributed to survival differences for Group A, and comorbidity contributed for both groups. Fully adjusted HR estimates were breast: Group A 1.65 (0.96-2.84), B 1.41 (0.95-2.09); colorectal: Group A 1.89 (1.12-3.17), B 1.25 (0.89-1.75)]. CONCLUSIONS The high burden of physical disease and delayed cancer diagnosis in those with psychotic disorders contributes to worse cancer survival in New Zealand psychiatric service users.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington.
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington
| | - James Stanley
- Department of Public Health, University of Otago Wellington
| | - Debbie Peterson
- Social Psychiatry and Population Mental Health Research Group, University of Otago Wellington
| | - Sunny Collings
- Social Psychiatry and Population Mental Health Research Group, University of Otago Wellington
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Freudenreich O, Huffman JC, Sharpe M, Beach SR, Celano CM, Chwastiak LA, Cohen MA, Dickerman A, Fitz-Gerald MJ, Kontos N, Mittal L, Nejad SH, Niazi S, Novak M, Philbrick K, Rasimas JJ, Shim J, Simpson SA, Walker A, Walker J, Wichman CL, Zimbrean P, Söllner W, Stern TA. Updates in Psychosomatic Medicine: 2014. PSYCHOSOMATICS 2015; 56:445-59. [DOI: 10.1016/j.psym.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/21/2023]
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