Cancer survival in the context of mental illness: a national cohort study
Cancer survival in the context of mental illness: a national cohort study
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DOI：
10.1016/j.genhosppsych.2015.06.003
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发表时间：
2015-11-01
影响因子：
7
通讯作者：
Collings, Sunny
中科院分区：
文献类型：
--
作者：
Cunningham, Ruth;Sarfati, Diana;Collings, Sunny
目的：探讨有精神疾病经历的人癌症生存率更差的原因，包括癌症类型和精神病diagnosis.Method的差异：新西兰乳腺癌和结直肠癌登记（2006-2010年）与成年人（18-64岁）的精神病住院记录相关联。使用考克斯回归分析比较近期精神科服务使用者和非使用者的癌症特异性生存率。对精神分裂症或双相情感障碍（A组）和其他使用精神卫生服务（B组）的患者进行了剥夺、合并症和诊断阶段的贡献评估。结果：在8762名乳腺癌和4022名结直肠癌患者中，分别有440名（乳腺癌）和190名（结直肠癌）最近接触过精神病服务。调整混杂因素后，A组[风险比（HR）2.55（95%置信区间1.49-4.35）]和B组[HR 1.62（1.09-2.39）]的乳腺癌死亡风险增加，A组[HR 2.92（1.75-4.87）]的结直肠癌死亡风险增加。诊断时的晚期促成了A组的生存差异，合并症促成了两组的生存差异。完全校正的HR估计值为乳腺：A组1.65（0.96-2.84），B 1.41（0.95-2.09）;结直肠：A组1.89（1.12-3.17），B 1.25（0.89-1.75）]。结论：在新西兰，精神障碍患者的身体疾病和癌症诊断延迟的高负担导致癌症生存率下降精神病服务使用者(c)2015爱思唯尔公司All rights reserved.
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. (c) 2015 Elsevier Inc. All rights reserved.