Kisely Steve, Forsyth Simon, Lawrence David
Discipline of Psychiatry, The School of Medicine, The University of Queensland, Herston, QLD, Australia Diamantina Health Partners, Princess Alexandra Hospital, Brisbane, QLD, Australia
School of Population Health, The University of Queensland, Herston, QLD, Australia.
Aust N Z J Psychiatry. 2016 Mar;50(3):254-63. doi: 10.1177/0004867415577979. Epub 2015 Mar 31.
Studies of overall cancer incidence and mortality in psychiatric patients have had mixed results. Some have reported lower than expected cancer incidence or mortality, while others have found no association or an increased risk depending on sample, psychiatric diagnosis, cancer site and methodology. Few studies have compared cancer incidence and mortality using the same population and methodology.
A population-based record-linkage analysis to compare cancer incidence and mortality in psychiatric patients with that for the general Queensland population, using an historical cohort to calculate age- and sex-standardised rate ratios and hazard ratios. Mental health records were linked with cancer registrations and death records from 2002 to 2007.
There were 89,992 new cancer cases, of which 3349 occurred in people with mental illness. Cancer incidence was the same as the general population for most psychiatric disorders. Rates were actually lower for dementia (hazard ratio = 0.77; 95% confidence interval = [0.67, 0.88]) and schizophrenia (hazard ratio = 0.84; 95% confidence interval = [0.72, 0.98]). By contrast, mortality was increased in psychiatric patients (hazard ratio = 2.27; 95% confidence interval = [2.15, 2.39]) with elevated hazard ratios for all the main psychiatric diagnoses.
Lifestyle, such as alcohol or tobacco use, would not explain our findings that people with mental illness are no more likely than the general population to develop cancer but more likely to die of it. Other factors may be the difficulty in differentiating medically explained and unexplained symptoms, greater case fatality or inequity in access to specialist procedures. The study highlights the need for improved cancer screening, detection and intervention in this population.
对精神病患者的总体癌症发病率和死亡率的研究结果不一。一些研究报告称癌症发病率或死亡率低于预期，而另一些研究则根据样本、精神病诊断、癌症部位和方法未发现关联或风险增加。很少有研究使用相同的人群和方法比较癌症发病率和死亡率。
基于人群的记录链接分析，以比较精神病患者与昆士兰普通人群的癌症发病率和死亡率，使用历史队列计算年龄和性别标准化率比及风险比。2002年至2007年的心理健康记录与癌症登记和死亡记录相链接。
有89,992例新癌症病例，其中3349例发生在患有精神疾病的人群中。大多数精神疾病的癌症发病率与普通人群相同。痴呆症（风险比=0.77；95%置信区间=[0.67, 0.88]）和精神分裂症（风险比=0.84；95%置信区间=[0.72, 0.98]）的发病率实际上更低。相比之下，精神病患者的死亡率增加（风险比=2.27；95%置信区间=[2.15, 2.39]），所有主要精神病诊断的风险比均升高。
生活方式，如饮酒或吸烟，无法解释我们的研究结果，即患有精神疾病的人患癌症的可能性并不比普通人群高，但死于癌症的可能性更大。其他因素可能是难以区分医学上可解释和无法解释的症状、更高的病死率或获得专科治疗的不平等。该研究强调了在这一人群中改善癌症筛查、检测和干预的必要性。
