癌症诊断前精神科就诊对实体恶性肿瘤生存的影响。
The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies.
机构信息
Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
出版信息
Br J Cancer. 2019 Apr;120(8):840-847. doi: 10.1038/s41416-019-0390-0. Epub 2019 Mar 6.
BACKGROUND
Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes.
METHODS
All residents of Ontario diagnosed with one of the top 10 malignancies (1997-2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM).
RESULTS
A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04-1.06), PUG 2 h 1.36 (95% CI 1.30-1.42), and PUG 3 h 1.73 (95% CI 1.63-1.84). Increasing PUG score was also associated with worse ACM.
CONCLUSIONS
Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.
背景
在癌症患者中，先前的研究表明，患有精神疾病的患者的生存率可能较低。本研究旨在评估癌症诊断前精神科就诊（PU）对生存结局的影响。
方法
纳入所有在安大略省被诊断为前 10 种恶性肿瘤之一的居民（1997-2014 年）。主要暴露因素为癌症诊断前 5 年的精神科就诊梯度（PUG）评分：0：无，1：门诊，2：急诊，3：住院。使用多变量、特定原因的风险模型评估 PUG 评分对癌症特异性死亡率（CSM）的影响，并使用 Cox 比例风险模型评估对全因死亡率（ACM）的影响。
结果
共纳入 676125 例患者：359465 例（53.2%）PUG 评分为 0，304559 例（45.0%）PUG 评分为 1，7901 例（1.2%）PUG 评分为 2，4200 例（0.6%）PUG 评分为 3。PUG 评分增加与 CSM 恶化独立相关，且与发病前 PU 强度的梯度相关（与 PUG 0 相比）：PUG 1 为 1.05（95%CI 1.04-1.06），PUG 2 为 1.36（95%CI 1.30-1.42），PUG 3 为 1.73（95%CI 1.63-1.84）。PUG 评分增加也与 ACM 恶化相关。
结论
癌症诊断前的 PU 与实体恶性肿瘤患者诊断后的 CSM 和 ACM 恶化独立相关。
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