Cancer-related mortality in people with mental illness

Kisely, Stephen, Crowe, Elizabeth and Lawrence D. (2012) Cancer-related mortality in people with mental illness. Archives of General Psychiatry, 70 2: 209-217. doi:10.1001/jamapsychiatry.2013.278

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Author Kisely, Stephen
Crowe, Elizabeth
Lawrence D.
Title Cancer-related mortality in people with mental illness
Journal name Archives of General Psychiatry   Check publisher's open access policy
ISSN 0003-990X
Publication date 2012-12-17
Sub-type Article (original research)
DOI 10.1001/jamapsychiatry.2013.278
Open Access Status File (Publisher version)
Volume 70
Issue 2
Start page 209
End page 217
Total pages 9
Place of publication Chicago, IL, United States
Publisher American Medical Association
Collection year 2013
Language eng
Formatted abstract
Context: There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis.

Objective: To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it.

Design, Setting, and Patients: A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia.

Main Outcome Measures: Metastases, incidence, mortality, and access to cancer interventions.

Results: There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio = 0.86; 95% CI, 0.82-0.90) and females (rate ratio = 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio = 1.52; 95% CI, 1.45-1.60; females: rate ratio = 1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio = 0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions.

Conclusions: Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published onlline 17 December 2012

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 45 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 45 times in Scopus Article | Citations
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Created: Wed, 16 Jan 2013, 14:16:21 EST by Geraldine Fitzgerald on behalf of School of Public Health