The effect of history of severe mental illness on mortality in colorectal cancer cases: a register-based cohort study
The effect of history of severe mental illness on mortality in colorectal cancer cases: a register-based cohort study
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DOI：
10.1080/0284186x.2018.1429649
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发表时间：
2018-01-01
期刊：
影响因子：
3.1
通讯作者：
Pukkala, Eero
中科院分区：
文献类型：
--
作者：
Manderbacka, Kristiina;Arffman, Martti;Pukkala, Eero
背景：虽然精神疾病和癌症存活率之间的联系已经确定，但很少有研究关注结直肠癌。材料和方法：我们从芬兰癌症登记中心确定了1990-2013年首次诊断为结直肠癌的患者(n=41,708)，从医院出院登记中确定了因严重精神疾病(SMI)而住院的患者(n=2382)，并对死亡原因进行了统计。结果：在有精神病史和药物使用障碍的人群中，我们发现结直肠癌死亡率过高。在控制了年龄、合并症、发病阶段和治疗阶段后，有精神病病史的男性额外死亡风险为1.72(1.46-2.04)，女性为1.37(1.20-1.57)。在有物质使用障碍的男性中，超额风险为1.22(1.09-1.37)。结论：了解导致有精神病病史或药物使用史的人死亡率过高的因素需要更详细的临床研究和对这些脆弱患者群体的护理过程的研究。需要患者、精神卫生保健和肿瘤学团队之间的合作来改善护理结果。
Background: While the link between mental illness and cancer survival is well established, few studies have focused on colorectal cancer. We examined outcomes of colorectal cancer among persons with a history of severe mental illness (SMI).Material and methods: We identified patients with their first colorectal cancer diagnosis in 1990-2013 (n=41,708) from the Finnish Cancer Registry, hospital admissions due to SMI preceding cancer diagnosis (n=2382) from the Hospital Discharge Register and deaths from the Causes of Death statistics. Cox regression models were used to study the impact on SMI to mortality differences.Results: We found excess colorectal cancer mortality among persons with a history of psychosis and with substance use disorder. When controlling for age, comorbidity, stage at presentation and treatment, excess mortality risk among men with a history of psychosis was 1.72 (1.46-2.04) and women 1.37 (1.20-1.57). Among men with substance use disorder, the excess risk was 1.22 (1.09-1.37). Conclusion: Understanding factors contributing to excess mortality among persons with a history of psychosis or substance use requires more detailed clinical studies and studies of care processes among these vulnerable patient groups. Collaboration between patients, mental health care and oncological teams is needed to improve outcomes of care.