Are Those With Serious Mental Illness More or Less Likely to Receive Cancer Screening?

Research Paper Title

Cancer Screening Among Adults With and Without Serious Mental Illness: A Mixed Methods Study.

Background

Persons with serious mental illness (SMI) die 10-20 years earlier than the general population; cancer is the second leading cause of death. Differences in cancer screening between SMI and the general population are not well understood.

Therefore the aim of this study was to describe receipt of cancer screening among individuals with versus without SMI and to explore clinicians’ perceptions around cancer screening for people with SMI.

Methods

Mixed-methods study using 2010-2017 MarketScan commercial insurance administrative claims data and semi-structured clinician interviews. In the quantitative analyses, we used multivariate logistic regression analyses to calculate the likelihood of receiving cervical, breast, colorectal, or prostate cancer screening among people with versus without SMI, defined as schizophrenia or bipolar disorder. We conducted semi-structured interviews with 17 primary care physicians and 15 psychiatrists. Interview transcripts were coded using a hybrid deductive/inductive approach.

Results

Relative to those without SMI, individuals with SMI were less likely to receive screening for cervical cancer [adjusted odds ratio (aOR): 0.80; 95% confidence interval (CI): 0.80-0.81], breast cancer (aOR: 0.79; 95% CI: 0.78-0.80), colorectal cancer (aOR: 0.90; 95% CI: 0.89-0.91), and prostate cancer (aOR: 0.85; 95% CI: 0.84-0.87). Clinicians identified 5 themes that may help explain the lower rates of cancer screening in persons with SMI: access to care, available support, prioritization of other issues, communication, and patient concerns.

Conclusions

People with SMI were less likely to receive 4 common types of cancer screening. Improving cancer screening rates in the SMI population will likely require a multidisciplinary approach to overcome barriers to screening.

Reference

Murphy, K.A., Stone, E.M., Presskreischer, R., McGinty, E.E., Daumit, G.L. & Pollack, C.E. (2021) Cancer Screening Among Adults With and Without Serious Mental Illness: A Mixed Methods Study. Medical Care. 59(4), pp.327-333. doi: 10.1097/MLR.0000000000001499.

Palliative/End of Life Care & Lung Cancer: With & Without Schizophrenia

Research Paper Title

Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study.

Background

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.

Methods

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 generalised 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.

Results

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.

Conclusions

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.

Reference

Viprey, M., Pauly, V., Salas, S., Baumstarck, K., Orleans, V., Llorca, P-M., Lancon, C., Auquier, P., Boyer, L. & Fond, G. (2020) Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study. European Archives of Psychiatry and Clinical Neuroscience. doi: 10.1007/s00406-020-01186-z. Online ahead of print.

What is the Association between PTSD & Cancer?

Research Paper Title

Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer.

Background

The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder.

Methods

The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression.

Results

A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = -0.21, p = 0.034) and the absence of relapse (β = -0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression.

Conclusions

Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.

Reference

Baniene, I. & Zemaitiene, N. (2020) Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer. Children (Basel, Switzerland). 7(9), pp.116. doi: 10.3390/children7090116.

Research: Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls

Research Paper Title:

Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls.

Author(s): Daniela Doege, Melissa S.Y. Thong, Lena Koch-Gallenkamp, Lina Jansen, Heike Bertram, Andrea Eberle, Bernd Holleczek, Ron Pritzkuleit, Annika Waldmann, Sylke R. Zeissig, Hermann Brenner, and Volker Arndt.

Year: 2020.

Journal: Cancer Medicine.

DOI: doi: 10.1002/cam4.3476. Online ahead of print.

Abstract:

Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long-term survivors. Study objectives were: (1) to compare the age-specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease-free BC survivors vs BC survivors with self-reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors.

Methods

About 3010 BC survivors (stage I-III, 5-16 years post-diagnosis), and 1005 population controls were recruited in German multi-regional population-based studies. Depression was assessed by the Geriatric Depression Scale-15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression.

Results

Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease-free survivors and controls, but prevalence in disease-free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression.

Conclusions

Long-term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinise screening and normalise referral to psychological care.

Linking PTSD and the Parents of Children with Cancer

Research Paper Title

Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer.

Background

The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder.

Methods

The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression.

Results

A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = -0.21, p = 0.034) and the absence of relapse (β = -0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression.

Conclusions

Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.

Reference

Baniene, I. & Zemaitiene, N. (2020) Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer. Children (Basel, Switzerland). 7(9), pp.116. doi: 10.3390/children7090116.

What is the Impact of Onset of Psychiatric Disorders & Psychiatric Treatment on Mortality Among Patients with Cancer?

Research Paper Title

Impact of Onset of Psychiatric Disorders and Psychiatric Treatment on Mortality Among Patients with Cancer.

Background

Psychiatric disorders are common in patients with cancer.

The impact of both psychiatric disorders and psychiatric treatment on mortality in patients with cancer needs to be established.

Methods

Nationwide claims data were analysed.

To investigate the association between psychiatric disorders and mortality, 6,292 male and 4,455 female patients with cancer who did not have a record of psychiatric disorders before cancer onset were included.

To examine the association between psychiatric treatment and mortality, 1,467 male and 1,364 female patients with cancer were included.

Incident psychiatric disorder and receipt of psychiatric treatment within 30 days from the onset of a psychiatric disorder were the main independent variables.

Dependent variables were all-cause and cancer-related mortality. Cox proportional hazards regression with time-dependent covariates was used.

Results

The onset of psychiatric disorders was associated with a significantly increased risk of mortality in both male (all-cause hazard ratio [HR]: 1.55; cancer-related HR: 1.47) and female patients with cancer (all-cause HR: 1.50; cancer-related HR: 1.44) compared with patients with cancer without psychiatric disorders.

Both male and female patients who received psychiatric treatment within 30 days of diagnosis of a psychiatric disorder had a lower risk of cancer-related mortality (males, HR: 0.73; females, HR: 0.71) compared with patients with cancer with psychiatric disorders who did not receive psychiatric treatment.

Conclusions

Patients with cancer with newly diagnosed psychiatric disorders had a higher mortality rate.

Among these, those who received psychiatric treatment showed lower rates of mortality.

Thus, early detection and early treatment of psychiatric disorders in patients with cancer is needed.

Implications for Practice

The current study supplements the body of evidence supporting the association of psychiatric disorders onset and treatment with cancer outcomes.

Patients with cancer showed an increased risk of both all-cause and cancer-related mortality upon psychiatric disorder onset.

Among patients with newly diagnosed psychiatric disorders, those who received psychiatric treatment showed lower cancer-related mortality.

Thus, raising awareness of both the risk of psychiatric disorders and the positive effects of psychiatric treatment on cancer outcomes is necessary among patients with cancer, caregivers, and oncologists.

Furthermore, it is necessary to adopt a multidisciplinary approach, encouraging patients with cancer to undergo a neuropsychological assessment of their mental health status and receive appropriate and timely psychological interventions.

Reference

Lee, S.A., Nam, C.M., Kim, Y.H., Kim, T.H., Jang, S.I., Park, E.C. (2020) Impact of Onset of Psychiatric Disorders and Psychiatric Treatment on Mortality Among Patients with Cancer. The Oncologist. doi: 10.1634/theoncologist.2019-0396. [Epub ahead of print].