Population-based comparison of cancer survival outcomes in patients with and without psychiatric disorders

Alexander Benny; Mary McLay; Russell C Callaghan; Alan Bates; Robert Olson

doi:10.1186/s12888-022-04191-9

Population-based comparison of cancer survival outcomes in patients with and without psychiatric disorders

BMC Psychiatry. 2022 Aug 11;22(1):543. doi: 10.1186/s12888-022-04191-9.

Authors

Alexander Benny¹, Mary McLay², Russell C Callaghan³, Alan Bates⁴, Robert Olson⁵

Affiliations

¹ Faculty of Medicine, University of British Columbia, Vancouver, Canada.
² Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
³ Division of Medical Sciences, University of Northern British Columbia, Prince George, Canada.
⁴ Department of Psychiatry, BC Cancer, University of British Columbia, Vancouver, Canada.
⁵ Department of Surgery, BC Cancer, University of British Columbia, 1215 Lethbridge Street, Prince George, BC V2M7E9, Canada. Rolson2@bccancer.bc.ca.

Abstract

Background: Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Patients with PD also potentially receive substandard care in comparison to the general population. Previous research has shown that individuals with PD have a decreased risk of receiving a tobacco related (TR) cancer diagnosis. To further assess this trend, this study assesses the survival of patients with a TR cancer with or without a PD.

Materials and methods: Our study utilized multiple databases, with methods described elsewhere,⁶ to identify people in British Columbia that have been diagnosed with psychiatric disorders and appendicitis (our control group). From these groups, we selected individuals who also had a TR cancer. We subsequently extracted information pertaining to these patients from these databases.

Results: Thirty-nine thousand eight hundred forty-one patients with cancer were included in our study. Analyses of these patients were controlled for by age, gender, cancer type and diagnosis year. This analysis displayed shorter survival time among patients who were diagnosed with depression (HR = 1.16; p = 0.01; 95% CI: 1.04-1.29), schizophrenia (HR = 1.62; p < 0.01; 95% CI: 1.43-1.84), or bipolar disorder (HR = 1.35; p < 0.01; 95% CI: 1.12-1.64) compared to the cancer patients without a PD, all of which were statistically significant. People that were diagnosed with anxiety disorders did not have a survival time that was significantly different from our control population (HR = 1.07; p = 0.22; 95% CI: 0.96-1.19).

Conclusions: Individuals with PD, except for those with anxiety, were found to have a shorter survival time following diagnosis with a TR cancer as compared to our control group. We hypothesize several factors, which may account for this statistically significant difference: (1) delayed diagnosis, (2) poor access to care, (3) poor assessment or follow-up, or (4) physician beliefs of poor treatment adherence.

Keywords: Bipolar Disorder; Cancer; Depression; Psychiatric Disorders; Schizophrenia; Survival.

MeSH terms

Anxiety
Anxiety Disorders / epidemiology
Bipolar Disorder* / epidemiology
Humans
Mental Disorders* / diagnosis
Mental Disorders* / therapy
Neoplasms*
Tobacco Use Disorder*