Kristiina Manderbacka, PhD, Martti Arffmar, MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Jaana Suvisaari, PhD, Aulikki Ahlgren-Rimpiläinen, PhD, National Institute for Health and Welfare, Mental Health, Helsinki, Finland; Sonja Lumme MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Ilmo Keskimäki, PhD, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland and Faculty of Social Sciences, University of Tampere, Finland; Eero Pukkala, PhD, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, and Faculty of Social Sciences, University of Tampere, Finland
Kristiina Manderbacka, PhD, Martti Arffmar, MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Jaana Suvisaari, PhD, Aulikki Ahlgren-Rimpiläinen, PhD, National Institute for Health and Welfare, Mental Health, Helsinki, Finland; Sonja Lumme MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Ilmo Keskimäki, PhD, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland and Faculty of Social Sciences, University of Tampere, Finland; Eero Pukkala, PhD, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, and Faculty of Social Sciences, University of Tampere, Finland.
Br J Psychiatry. 2017 Nov;211(5):304-309. doi: 10.1192/bjp.bp.117.198952. Epub 2017 Sep 21.
Earlier research suggests poorer outcome of cancer care among people with severe mental illness (SMI).To assess the effect of stage at presentation, comorbidities and treatment on differences in survival among cancer patients with and without a history of SMI in Finland.The total population with a first cancer diagnosis in 1990-2013 was drawn from the Finnish Cancer Registry. Hospital admissions because of SMI and deaths were obtained from administrative registers. We calculated Kaplan-Meier estimates and Cox regression models to examine survival differences.We found excess mortality in people with a history of psychotic and substance use disorders. Cancer stage and comorbidity did not explain mortality differences. Controlling for cancer treatment decreased the differences. The mortality gap between patients with psychosis and cancer patients without SMI increased over time.Integrated medical and psychiatric care is needed to improve outcomes of cancer care among patients with SMI.
早期研究表明，患有严重精神疾病（SMI）的人癌症治疗效果较差。为了评估在芬兰，癌症患者有无 SMI 病史的生存差异，本研究评估了就诊时的分期、合并症和治疗的影响。1990-2013 年的首次癌症诊断患者全部来自芬兰癌症登记处。精神疾病住院和死亡人数则从行政登记中获得。我们计算了 Kaplan-Meier 估计和 Cox 回归模型来检验生存差异。我们发现有精神病史的患者死亡率过高。癌症分期和合并症并不能解释死亡率的差异。控制癌症治疗后，差异缩小。患有精神病的癌症患者和无 SMI 的癌症患者之间的死亡率差距随着时间的推移而增加。需要整合医疗和精神科护理，以改善 SMI 患者的癌症治疗效果。
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