Differences in cancer stage, treatment and in-hospital mortality between patients with and without schizophrenia: retrospective matched-pair cohort study

Hanako Ishikawa; Hideo Yasunaga; Hiroki Matsui; Kiyohide Fushimi; Norito Kawakami

doi:10.1192/bjp.bp.114.156265

Differences in cancer stage, treatment and in-hospital mortality between patients with and without schizophrenia: retrospective matched-pair cohort study

Br J Psychiatry. 2016 Mar;208(3):239-44. doi: 10.1192/bjp.bp.114.156265. Epub 2015 Nov 19.

Authors

Hanako Ishikawa¹, Hideo Yasunaga², Hiroki Matsui¹, Kiyohide Fushimi¹, Norito Kawakami¹

Affiliations

¹ Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan yasunagah-tky@umin.ac.jp.

PMID: 26585096
DOI: 10.1192/bjp.bp.114.156265

Abstract

Background: Healthcare access and outcomes in cancer patients with schizophrenia remain unclear.

Aims: To investigate the likelihood of early diagnosis and treatment in patients with schizophrenia who have cancer and their prognosis.

Method: A retrospective matched-pair cohort of gastrointestinal cancer patients was identified using a national in-patient database in Japan. Multivariable ordinal/binary logistic regressions was modelled to compare cancer stage at admission, invasive treatments and 30-day in-hospital mortality between patients with schizophrenia (n = 2495) and those without psychiatric disorders (n = 9980).

Results: The case group had a higher proportion of stage IV cancer (33.9% v. 18.1%), a lower proportion of invasive treatment (56.5% v. 70.2%, odds ratio (OR) = 0.77, 95% CI 0.69-0.85) and higher in-hospital mortality (4.2% v. 1.8%, OR = 1.35, 95% CI 1.04-1.75).

Conclusions: Patients with schizophrenia who had gastrointestinal cancer had more advanced cancer, a lower likelihood of invasive treatment and higher in-hospital mortality than those without psychiatric disorders.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Databases, Factual
Endoscopy
Female
Gastrointestinal Neoplasms / complications*
Gastrointestinal Neoplasms / mortality*
Gastrointestinal Neoplasms / surgery
Hospital Mortality*
Humans
Japan
Length of Stay
Life Expectancy
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging*
Odds Ratio
Prognosis
Retrospective Studies
Risk Factors
Schizophrenia / diagnosis*
Severity of Illness Index