CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
Department of Epidemiology and Health Economics, APHM, Marseille, France.
Eur Arch Psychiatry Clin Neurosci. 2021 Dec;271(8):1571-1578. doi: 10.1007/s00406-020-01186-z. Epub 2020 Sep 2.
Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014-2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p < 0.0001; surgery 0.73 [0.59;0.90]; p < 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.
精神分裂症患者在癌症治疗方面存在不平等现象，且吸烟率较高。因此，与没有精神障碍的肺癌患者相比，患有精神分裂症的肺癌患者在临终关怀方面可能面临更高的风险。本研究旨在比较患有精神分裂症和肺癌的患者与没有严重精神障碍的患者的临终关怀。本基于人群的队列研究纳入了所有在法国医院因晚期肺癌死亡的年龄在 15 岁及以上的患者（2014-2016 年）。选择了精神分裂症患者和没有严重精神障碍的对照组，并比较了姑息治疗和高强度临终关怀的指标。采用多变量广义对数线性模型，调整了性别、年龄、死亡年份、社会剥夺、癌症诊断与死亡之间的时间、转移、合并症、吸烟成瘾和医院类别。该分析共纳入了 633 名精神分裂症患者和 66469 名对照组。精神分裂症患者死亡年龄早 6 年，吸烟成瘾的比例几乎高出两倍（38.1%），患有慢性肺部疾病的比例更高（32.5%），癌症诊断与死亡之间的时间更短。在多变量分析中，他们接受姑息治疗的比例更高（调整后的优势比 1.27 [1.03；1.56]；p=0.04），且高强度的临终关怀（如化疗 0.53 [0.41；0.70]；p<0.0001；手术 0.73 [0.59；0.90]；p<0.01）更少。尽管患有肺癌的精神分裂症患者对高强度临终关怀的使用和/或延续性的重视程度较低，但有些发现表明他们失去了机会。未来的研究应探讨精神分裂症和肺癌患者的期望，以确定最佳的临终关怀方案。
