Authors:
Kisely S; Crowe E; Lawrence D
Authors notes:
JAMA Psychiatry. 2013;70(2):209-217
Keywords:
Mental illness, Cancer, Mortality, Metastases
Abstract:
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.
To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it.
There were 6586 new cancers in psychiatric patients.
Cancer incidence was lower in psychiatric patients than in the general population in both males and females, although mortality was higher.
The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients than in the general population.
Psychiatric patients had a reduced likelihood of surgery, especially resection of colorectal, breast, and cervical cancers.
They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions.
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.