Department of Community Health Sciences, Manitoba Centre for Health Policy University of Manitoba, Winnipeg, Manitoba, Canada.
ICES, Toronto, Ontario, Canada.
PLoS One. 2020 Jul 29;15(7):e0235409. doi: 10.1371/journal.pone.0235409. eCollection 2020.
To identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation.
Population-based retrospective cohort study using linked cancer registry and administrative data at ICES.
The universal healthcare system in Ontario, Canada.
Colorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'.
Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation.
24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses.
Individuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.
确定有严重精神病史 (SPI) 的癌症患者与无精神病史的癌症患者的生存率差异，并探讨推荐癌症治疗的提供情况差异，以解释潜在原因。
使用 ICES 链接的癌症登记处和行政数据进行基于人群的回顾性队列研究。
加拿大安大略省的全民医疗保健系统。
2007 年 4 月 1 日至 2012 年 12 月 31 日期间被诊断患有结直肠癌 (CRC) 的患者。SPI 病史（精神分裂症、分裂情感障碍、其他精神病性障碍、双相情感障碍或重性抑郁障碍）通过住院、急诊和精神科就诊数据确定，并分为“无精神病史”、“门诊 SPI 病史”和“住院 SPI 病史”。
癌症特异性生存率、未接受手术切除以及未接受辅助化疗或放疗。
共纳入 24507 例 CRC 患者，其中 482 例（2.0%）有门诊 SPI 病史，258 例（1.0%）有住院 SPI 病史。有 SPI 病史的个体生存率显著较低，与无精神病史的 CRC 患者相比，接受指南推荐治疗的可能性显著较低。住院 SPI 个体的癌症特异性死亡调整后的 HR 为 1.69 倍（95%CI 1.36-2.09），门诊 SPI 病史个体的 HR 为 1.24 倍（95%CI 1.04-1.48）。住院 SPI 病史的 II 期和 III 期 CRC 患者接受潜在治愈性手术切除的可能性低 2.15 倍（95%CI 1.07-4.33），接受辅助放疗或化疗的可能性低 2.07 倍（95%CI 1.72-2.50）。这些发现在多次敏感性分析中均一致。
在全民医疗保健系统中，有 SPI 病史的个体在结直肠癌护理和生存方面存在不平等现象。需要增加倡导力度并提供资源，以支持癌症系统内的 SPI 个体，以减少不必要的伤害。
