National Institute for Health and Welfare, Health and Social Systems Research, P.O.Box 30, 00271 Helsinki, Finland.
National Institute for Health and Welfare, Health and Social Systems Research, P.O.Box 30, 00271 Helsinki, Finland.
Eur J Cancer. 2019 Sep;118:105-111. doi: 10.1016/j.ejca.2019.06.018. Epub 2019 Jul 19.
Although the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment.
We identified patients with their first lung cancer diagnosis in 1990-2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HRs) for the impact of SMI on mortality.
Of the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with a history of psychosis had excess mortality risk (HR = 1.24, 1.06-1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR = 1.76, 1.41-2.19) and in squamous cell carcinoma (HR = 1.67, 1.26-2.20) and among women with mood disorders in adenocarcinoma (HR = 1.37, 1.08-1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s.
We found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental healthcare professionals and oncological teams is needed to reduce the mortality gap between patients with cancer with and without SMI.
尽管严重精神疾病（SMI）与癌症死亡率升高之间存在关联已得到充分证实，但很少有研究详细探讨肺癌生存与 SMI 之间的关系。我们的研究比较了有和无 SMI 病史的肺癌患者的癌症特异性死亡率，并分析了癌症分期、合并症或癌症治疗差异是否可以解释死亡率差异。
我们从芬兰癌症登记处确定了 1990 年至 2013 年间首次诊断为肺癌的患者，从住院记录中确定了他们因 SMI 而住院的记录，从死因统计数据中确定了死亡记录。使用竞争风险分析来估计 SMI 对死亡率的影响的风险比（HR）。
在 37852 例肺癌病例中，有 12%的患者有 SMI 病史。在控制了分期和治疗后，某些癌症类型的患者组之间存在癌症特异性死亡率差异。有精神病史的男性患鳞状细胞癌的死亡率风险增加（HR=1.24，1.06-1.45）。有精神病史的女性患小细胞癌（HR=1.76，1.41-2.19）和鳞状细胞癌（HR=1.67，1.26-2.20）以及有心境障碍的女性患腺癌（HR=1.37，1.08-1.74）的死亡率风险也存在类似的超额风险。在五年死亡率方面，患者组之间的 HR 差异在 20 世纪 90 年代并没有明显改变。
我们发现有 SMI 病史的患者的癌症特异性死亡率升高。需要患者、精神卫生保健专业人员和肿瘤团队之间的合作，以缩小有和无 SMI 的癌症患者之间的死亡率差距。
