Department of Surgery, Saint Louis University Medical Center, 3635 Vista Avenue, St. Louis, MO 63110-0250, USA.
Am J Surg. 2013 Nov;206(5):798-804. doi: 10.1016/j.amjsurg.2012.06.013. Epub 2013 Jul 12.
Schizophrenia has a powerful impact on the outcomes of treatment for physical disorders. This study sought to estimate how the presence of schizophrenia disrupts the course of diagnosis and initial treatment of breast cancer.
We searched the Patient Treatment File, a comprehensive computer-based system for inpatient data in the Department of Veterans Affairs (DVA) medical system, to identify patients with codes for schizophrenia or schizoaffective disorder who later developed breast cancer. These data were augmented with chart-based clinical data.
There were 56 evaluable patients from 34 DVA facilities; 37 (66%) were female. Delay in diagnosis was common. The mean size of the primary tumor was 4 cm in those for whom these data were recorded. Delay in diagnosis was common and many never received the indicated surgery. Distant metastases were present on diagnosis in 12 (21%) and developed after diagnosis in 14 (25%) others, including 7 who inappropriately delayed or refused indicated surgery and 4 who inappropriately delayed or refused indicated neoadjuvant chemotherapy. Twelve verbally abused or physically attacked caregivers.
Patients with schizophrenia who later develop breast cancer often deny they have cancer. They often have high-stage disease at diagnosis and often delay or refuse therapy. Breast-conserving multimodality therapy is often not feasible.
精神分裂症对躯体疾病治疗结局有重大影响。本研究旨在评估精神分裂症对乳腺癌诊断和初始治疗过程的影响。
我们检索了退伍军人事务部（VA）医疗系统患者治疗档案，这是一个综合的基于计算机的住院患者数据系统，以确定后来患有乳腺癌且有精神分裂症或分裂情感性障碍编码的患者。这些数据通过基于图表的临床数据进行补充。
从 34 个 VA 机构中选出 56 例可评估患者；37 例（66%）为女性。诊断延迟很常见。记录到这些数据的患者中，原发性肿瘤的平均大小为 4 厘米。诊断延迟很常见，许多患者从未接受过规定的手术。12 例（21%）患者在诊断时已有远处转移，另外 14 例（25%）患者在诊断后发生远处转移，包括 7 例患者因不当延误或拒绝手术，4 例患者因不当延误或拒绝新辅助化疗。有 12 名护理人员遭受言语虐待或身体攻击。
后来患有乳腺癌的精神分裂症患者常否认患有癌症。他们往往在诊断时处于高分期疾病，并且常常延误或拒绝治疗。保乳多模式治疗通常不可行。
